Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program

被引:24
作者
Taniguchi, Hideki [1 ,4 ]
Sasaki, Toshio [2 ]
Fujita, Hisae [2 ]
Kobayashi, Hiroko [2 ]
Kawasaki, Rieko [2 ]
Ogata, Takashi [3 ]
Cho, Haruhiko [3 ]
Yoshikawa, Takaki [3 ]
Ushigome, Keiko [1 ]
Tanaka, Akemi [1 ]
Takano, Osami [2 ]
机构
[1] Kanagawa Univ Human Serv, Fac Human Serv, Dept Nutr, 1-10-1 Heisei, Yokosuka, Kanagawa 2388522, Japan
[2] Kanagawa Canc Ctr, Dept Anaesthesiol, Asahi Ku, 2-3-2 Nakao, Yokohama, Kanagawa 2418515, Japan
[3] Kanagawa Canc Ctr, Dept Gastrointestinal Surg, Asahi Ku, 2-3-2 Nakao, Yokohama, Kanagawa 2418515, Japan
[4] Saiseikai Yokohamashi Tobu Hosp, Perioperat Support Ctr, Tsurumi Ku, 3-6-1 Shimo Sueyoshi, Yokohama, Kanagawa 2308765, Japan
关键词
Goal-directed fluid therapy (GDT); Enhanced recovery after surgery (ERAS); Oesophagectomy; Postoperative gastrointestinal recovery; Postoperative mobilisation;
D O I
10.1016/j.clnesp.2017.10.002
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background and aims: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. Methods: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. Results: The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002). Conclusions: The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. (c) 2017 The Authors. Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism.
引用
收藏
页码:184 / 193
页数:10
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