Comparative balanced salt solution and 6 % hydroxyethyl starch in goal-directed therapy for major abdominal surgery: A systematic review and meta-analysis

Goal-directed fluid therapy (GDFT) improves postoperative outcomes in various surgeries, but the optimal fluid choice between balanced salt solutions (BSS) and hydroxyethyl starch (HES) remains debated. This meta-analysis compared postoperative outcomes of GDFT using BSS versus 6 % HES in elective major abdominal surgery. Comprehensive database searches identified eight RCTs (1739 patients) published between 2000 and 2024. No significant differences were found in overall postoperative complications [RR 1.04 (95 % CI 0.90-1.20); p 1/4 0.59], including renal, cardiovascular, respiratory complications, or mortality. However, BSS required significantly higher intraoperative fluid volumes [SMD 0.61 (95 % CI 0.42-0.80); p < 0.001] and led to greater postoperative fluid balance [SMD 0.39 (95 % CI 0.20-0.59); p < 0.001]. 6 % HES should not be used routinely. GDFT using BSS achieves the same outcomes at a lower cost and without the risk of bleeding.