Impact of a goal directed therapy in the implementation of an ERAS (Enhanced recovery after surgery) protocol in laparoscopic radical cystectomy

OBJECTIVES: The intraoperative goal directed fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy. METHODS: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT. Group B (n=18) included patients before the GDT introduction in our practice. The main objective was to assess the length of hospital stay and the permanence in intensive care units. Other variables of the study were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Statistical analysis was performed using the Mann Whitney U test for non-parametric variables and the Chi-square test for qualitative variables. Fisher's exact test was used when the sample size required it. RESULTS: The average length of hospital stay was 13.4 SD (11.0-75.9) days in group A versus 11.6 SD (8.9-14.3) days in group B (p <0.364). The average stay in critical care unit was 25.4 hours (16.1-34.6) in group A versus 21.0 (14.9-27.7) hours in group B with no significant differences between groups. The use of blood products was 0.41 packed red blood cells in group A versus 0.49 in group B with no statistically significant differences. The average volume of crystalloid administered was 1145 ml in group A versus 2382 ml in group B (p <0.001). In group A 656 ml of colloids were administered versus 266 ml in group B (p <0.001). There were no statistically significant differences in the incidence of complications. CONCLUSIONS: The use of a Goal Directed Fluid Therapy in radical cystectomy is related to a greater use of colloids than crystalloids, although its implementation does not affect hospital stay length or postoperative complications. In a multimodal perioperative program a single factor, as it is for the GDT, has little effect as an independent variable, and the combination of strategies has, more likely, a greater effect.