Abstract
Purpose
The aim of this study is to evaluate the intra/perioperative fluid management and early postoperative outcomes of patients who underwent radical cystectomy with Enhanced Recovery After Surgery protocol, using goal-directed fluid therapy compared to conventional fluid therapy.
Methods
This cohort study included patients who underwent open RC for urothelial bladder carcinoma with intent to cure and Enhanced Recovery After Surgery protocol between May 2012 and August 2019. Patients who had palliative or salvage cystectomy and/or adjunct procedures, as well as those with missing detailed perioperative data were excluded. Data were compared between patients who received goal-directed fluid therapy using stroke volume variation by FloTrac™/Vigileo system (n = 119) and conventional fluid therapy based on the anesthesiologist discretion (n = 192). Primary outcome variable was 90-day complications and secondary outcome measures included in-hospital GFR trend, length of stay, and 90-day readmission.
Results
The goal-directed fluid therapy group received less total and net intra/perioperative fluid, yet early postoperative glomerular filtration rate trends were similar between both groups (p = 0.7). Estimated blood loss, blood transfusion, index hospital stay, 90-day complication and readmission rates were also comparable between the two groups. Multivariable logistic regression showed no significant association between perioperative fluid management method and 90-day complication rate (OR 1.4, 95% CI 0.8–2.4, p = 0.2).
Conclusion
Stroke volume variation guided goal-directed fluid therapy is safe in radical cystectomy without compromising the renal function. It is associated with less intra- and perioperative fluid infusion; however, no association with hospital stay, 90-day complication or readmission rates were noted.
Similar content being viewed by others
References
Siegel RL, Miller KD, Jemal A (2020) Cancer statistics. CA Cancer J Clin 70:7–30. https://doi.org/10.3322/caac.21590
Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164–174. https://doi.org/10.1016/j.eururo.2008.07.031
Daneshmand S, Ahmadi H, Schuckman AK et al (2014) Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol 192:50–55. https://doi.org/10.1016/j.juro.2014.01.097
Djaladat H, Katebian B, Bazargani ST et al (2017) 90-Day complication rate in patients undergoing radical cystectomy with enhanced recovery protocol: a prospective cohort study. World J Urol 35:907–911. https://doi.org/10.1007/s00345-016-1950-z
Tyson MD, Chang SS (2016) Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes. Eur Urol 70:995–1003. https://doi.org/10.1016/j.eururo.2016.05.031
Pozo C, Shariat SF, D’Andrea D et al (2019) Enhanced recovery after radical cystectomy. Curr Opin Urol 29:227–238. https://doi.org/10.1097/MOU.0000000000000594
Bundgaard-Nielsen M, Secher NH, Kehlet H (2009) “Liberal” vs. “restrictive” perioperative fluid therapy-a critical assessment of the evidence. Acta Anaesthesiol Scand 53:843–851. https://doi.org/10.1111/j.1399-6576.2009.02029.x
Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM (2012) Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg 114:640–651. https://doi.org/10.1213/ANE.0b013e318240d6eb
Chappell D, Jacob M, Hofmann-Kiefer K et al (2008) A rational approach to perioperative fluid management. Anesthesiology 109:723–740. https://doi.org/10.1097/ALN.0b013e3181863117
Scheeren TW, Wiesenack C, Gerlach H et al (2013) Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput 27:225–233. https://doi.org/10.1007/s10877-013-9461-6
Ramsingh DS, Sanghvi C, Gamboa J et al (2013) Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. J Clin Monit Comput 27:249–257. https://doi.org/10.1007/s10877-012-9422-5
Bazargani ST, Ghodoussipour S, Tse B et al (2018) The association between intraoperative fluid intake and postoperative complications in patients undergoing radical cystectomy with an enhanced recovery protocol. World J Urol 36:401–407. https://doi.org/10.1007/s00345-017-2164-8
Skinner DG, Lieskovsky G (1998) Management of invasive high-grade bladder cancer. In: Skinner DG, Lieskovsky G (eds) Diagnosis and management of genitourinary cancer, vol 1. Saunders, Philadelphia, pp 295–312
Ghodoussipour S, Djaladat H (2018) An update in enhanced recovery following radical cystectomy. Curr Urol Rep 19:98. https://doi.org/10.1007/s11934-018-0855-3
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Wuethrich PY, Burkhard FC, Thalmann GN et al (2014) Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology 20:365–377. https://doi.org/10.1097/ALN.0b013e3182a44440
Furrer MA, Schneider MP, Löffel LM et al (2018) Impact of intra-operative fluid and noradrenaline administration on early postoperative renal function after cystectomy and urinary diversion: a retrospective observational cohort study. Eur J Anaesthesiol 35:641–640. https://doi.org/10.1097/EJA.0000000000000808
Kendrick JB, Kaye AD, Tong Y et al (2019) Goal-directed fluid therapy in the perioperative setting. J Anaesthesiol Clin Pharmacol 35:S29–S34. https://doi.org/10.4103/joacp.JOACP_26_18
Arslan-Carlon V, Tan KS, Dalbagni G et al (2020) Goal-directed versus standard fluid therapy to decrease ileus after open radical cystectomy: a prospective randomized controlled trial. Anesthesiology 133:293–303. https://doi.org/10.1097/ALN.0000000000003367
Kabon B, Sessler DI, Kurz A (2019) Crystalloid-colloid study team. Effect of intraoperative goal-directed balanced crystalloid versus colloid administration on major postoperative morbidity: a randomized trial. Anesthesiology 130:728–744. https://doi.org/10.1097/ALN.0000000000002601
Gómez-Izquierdo JC, Trainito A, Mirzakandov D et al (2017) Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a randomized controlled trial. Anesthesiology 127:36–49. https://doi.org/10.1097/ALN.0000000000001663
Benes J, Giglio M, Brienza N et al (2014) The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care 18:584. https://doi.org/10.1186/s13054-014-0584-z
Deng QW, Tan WC, Zhao BC et al (2018) Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis. Crit Care 22:298. https://doi.org/10.1186/s13054-018-2251-2
Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG et al (2018) Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial). Br J Anaesth 120:734–744. https://doi.org/10.1016/j.bja.2017.12.018
Pillai P, McEleavy I, Gaughan M et al (2011) A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol 186:2201–2206. https://doi.org/10.1016/j.juro.2011.07.093
Patel SY, Garcia Getting RE, Alford B et al (2018) Improved outcomes of Enhanced Recovery After Surgery (ERAS) protocol for radical cystectomy with addition of a multidisciplinary care process in a US comprehensive cancer care center. World J Surg 42:2701–2707. https://doi.org/10.1007/s00268-018-4665-z
Myles PS, Bellomo R, Corcoran T et al (2018) Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med 378:2263–2274. https://doi.org/10.1056/NEJMoa1801601
Hanna PT, Peterson M, Albersheim J et al (2020) Acute kidney injury following enhanced recovery after surgery in patients undergoing radical cystectomy. J Urol 204:982–988. https://doi.org/10.1097/JU.0000000000001153
Kong YG, Kim JY, Yu J et al (2016) Efficacy and safety of stroke volume variation-guided fluid therapy for reducing blood loss and transfusion requirements during radical cystectomy: a randomized clinical trial. Medicine 95:e3685. https://doi.org/10.1097/MD.0000000000003685
Funding
None.
Author information
Authors and Affiliations
Contributions
AG: data collection/management and manuscript writing/editing. MFB: data collection and manuscript writing/editing. SG: data collection and manuscript writing/editing. STB: data collection. EA: data collection/analysis. MA: data collection. JC: data analysis. GM: data collection/management. SS: critical review and supervision. SB: critical review and supervision. AKS: critical review and supervision. SD: protocol/project development, critical review and supervision. PL: critical review and supervision, manuscript writing/editing. HD: protocol/project development, critical review and supervision, and manuscript writing/editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ghoreifi, A., Basin, M.F., Ghodoussipour, S. et al. Perioperative outcomes of goal-directed versus conventional fluid therapy in radical cystectomy with enhanced recovery protocol. Int Urol Nephrol 53, 1827–1833 (2021). https://doi.org/10.1007/s11255-021-02903-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-021-02903-w