Impact of Perioperative Goal-Directed Fluid Therapy on Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery

Abstract

Background and Objectives: Major abdominal surgeries are associated with significant physiological stress, leading to fluid shifts, blood loss, and potential postoperative complications. Optimal perioperative fluid management plays a crucial role in maintaining hemodynamic stability, ensuring adequate organ perfusion, and improving surgical outcomes. This study evaluates the impact of perioperative goal-directed fluid therapy (GDFT) on postoperative outcomes in patients undergoing major abdominal surgery.
Methods: This prospective, randomized controlled trial (RCT) included adult patients (≥ 18 years) scheduled for major abdominal surgery, randomly assigned to either a GDFT group or a standard fluid therapy group. Patients with pre-existing cardiac, renal, or hepatic dysfunction, as well as those undergoing emergency surgeries, were excluded. Randomization was conducted using computer-generated numbers, and blinding of participants and outcome assessors minimized bias. Intraoperative hemodynamic monitoring (mean arterial pressure, cardiac output, and stroke volume variation) guided fluid bolus administration in the GDFT group, while the standard therapy group received fluids based on conventional clinical parameters. Postoperative outcomes were assessed up to 30 days post-surgery, including complications, length of hospital stay, and patient satisfaction.
Results: A total of 240 patients were enrolled (GDFT group: n=120, Standard therapy group: n=120). The GDFT group experienced significantly lower rates of surgical site infections (8.3% vs. 18.3%; p=0.02), anastomotic leaks (4.2% vs. 11.7%; p=0.01), and pulmonary complications (6.7% vs. 16.7%; p=0.01). The length of hospital stay was shorter in the GDFT group (7.5 ± 1.8 days) compared to the standard therapy group (10.3 ± 2.2 days; p<0.001). Patient satisfaction and postoperative quality of life scores were significantly higher in the GDFT group (p<0.001), while mortality rates did not differ significantly between the two groups (1.7% vs. 2.5%; p=0.65).
Conclusion: Perioperative goal-directed fluid therapy significantly improves postoperative outcomes in patients undergoing major abdominal surgery by reducing complications, shortening hospital stays, and enhancing patient satisfaction. These findings support the integration of GDFT into routine perioperative care protocols for major abdominal surgeries.