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Perioperative outcomes of goal-directed versus conventional fluid therapy in radical cystectomy with enhanced recovery protocol

  • Urology - Original Paper
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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.

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Authors and Affiliations

Authors

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

Correspondence to Hooman Djaladat.

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The authors declare that they have no conflict of interest.

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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.

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Informed consent was obtained from all individual participants included in the study.

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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

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  • DOI: https://doi.org/10.1007/s11255-021-02903-w

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