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Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis
H D Aya1, M Cecconi, M Hamilton
1St George's Hospital NHS Trust and St George's University of London, London SW170QT, UK.
Insights
Perioperative goal-directed hemodynamic therapy (GDT) in cardiac surgery significantly reduces postoperative complications and hospital stay. While GDT shows promise, it did not significantly impact mortality rates in this meta-analysis.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Postoperative morbidity remains a significant concern in cardiac surgery despite declining mortality rates.
- Goal-directed hemodynamic therapy (GDT) has shown benefits in non-cardiac surgery, but its impact on cardiac surgery is less clear.
- Evidence for perioperative GDT in cardiac surgery requires further meta-analysis.
Purpose of the Study:
- To conduct a meta-analysis evaluating the effects of perioperative GDT on mortality, morbidity, and hospital length of stay in cardiac surgical patients.
- To synthesize existing evidence on the efficacy of GDT in the perioperative cardiac surgery setting.
- To provide a quantitative assessment of GDT's impact on key outcomes in cardiac surgery.
Main Methods:
- Systematic review of randomized controlled trials from Medline, EMBASE, and Cochrane Controlled Trials Register.
- Inclusion criteria: randomized controlled trials, reported mortality, pre-emptive hemodynamic intervention, and cardiac surgical population.
- Data synthesis using random-effects model with odds ratios and mean differences for quantitative analysis.
Main Results:
- Five studies (699 patients) met inclusion criteria.
- GDT significantly reduced postoperative complication rates (OR 0.33, 95% CI 0.15-0.73; P=0.006).
- GDT significantly decreased hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0.003), with no significant reduction in mortality.
Conclusions:
- Perioperative GDT is effective in reducing morbidity following cardiac surgery.
- The use of pre-emptive GDT in cardiac surgery leads to a shorter hospital length of stay.
- Further research may be needed to explore GDT's impact on mortality in specific cardiac surgical subgroups.
Background:
Perioperative mortality after cardiac surgery has decreased in recent years although postoperative morbidity is still significant. Although there is evidence that perioperative goal-directed haemodynamic therapy (GDT) may reduce surgical mortality and morbidity in non-cardiac surgical patients, the data are less clear after cardiac surgery. The objective of this review is to perform a meta-analysis on the effects of perioperative GDT on mortality, morbidity, and length of hospital stay in cardiac surgical patients.
Methods:
We conducted a systematic review using Medline, EMBASE, and the Cochrane Controlled Clinical Trials Register. Additional sources were sought from experts. The inclusion criteria were randomized controlled trials, mortality reported as an outcome, pre-emptive haemodynamic intervention, and cardiac surgical population. Included studies were examined in full and subjected to quantifiable analysis, subgroup analysis, and sensitivity analysis where possible. Data synthesis was obtained by using odds ratio (OR) and mean difference (MD) for continuous data with 95% confidence interval (CI) utilizing a random-effects model.
Results:
From 4986 potential studies, 5 met all the inclusion criteria (699 patients). The quantitative analysis showed that the use of GDT reduced the postoperative complication rate (OR 0.33, 95% CI 0.15-0.73; P=0,006) and hospital length of stay (MD -2.44, 95% CI -4.03 to -0.84; P=0,003). There was no significant reduction in mortality.
Conclusion:
The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay.
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