Exploring the relationship between adherence to a goal-directed fluid therapy protocol and outcome after major surgery

The primary aim of this retrospective study was to evaluate whether adherence to a goal-directed fluid-therapy (GDFT) protocol affects the occurrence of postoperative complications in patients undergoing pancreaticoduodenectomy. The secondary aim was to investigate the relationship between blood loss and adherence to GDFT protocol. As adherence to GDFT varies widely during high-risk surgery, we hypothesized that patients in the best quartile of adherence (>75%) had a better outcome when compared with those of the worst quartile (with adherence <=25%). One hundred and three patients scheduled for pancreaticoduodenectomy underwent a stroke volume (SV)-guided fluid therapy using an uncalibrated pulse contour device (Vigileo/FloTrac system version 4.0, Edwards Lifesciences, Irvine, California, USA) according to the NICE (National Institute for Health and Care excellence) protocol. The main finding of this study, with limitations because of the retrospective design, was that adherence to GDFT protocol may affect postoperative complication rate. In particular, we found a relevant lower postoperative complication rate when adherence was above 75%. Furthermore, blood loss was the main factor influencing the patient’s deviation from SV trigger.