학술논문
Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study
Document Type
Academic Journal
Author
Source
BMC Anesthesiology. January 9, 2023, Vol. 23 Issue 1
Subject
Language
English
ISSN
1471-2253
Abstract
Author(s): Morgan Le Guen[sup.1], Amandine Le Gall-Salaun[sup.2], Julien Josserand[sup.1], Augustin Gaudin de Vilaine[sup.3], Simon Viquesnel[sup.2], Damien Muller[sup.4], Bertrand Rozec[sup.4,5], Kévin Buffenoir Billet[sup.6], Raphaël Cinotti[sup.7,8], Amélie Yavchitz, Stéphanie Sigault, Aurélien Mazereaud, [...]
Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size [greater than or equal to] 35 mm and/or mid-line shift [greater than or equal to] 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation [greater than or equal to] 48 h and in-hospital mortality. Results From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). Conclusions In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery. Keywords: Craniotomy, Goal directed fluid therapy, Outcome, Postoperative complications
Background Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery. Methods We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size [greater than or equal to] 35 mm and/or mid-line shift [greater than or equal to] 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation [greater than or equal to] 48 h and in-hospital mortality. Results From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05). Conclusions In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery. Keywords: Craniotomy, Goal directed fluid therapy, Outcome, Postoperative complications