Meta-analysis of the effect of goal-directed therapy on bowel function after abdominal surgery

Abstract

Background: Intraoperative goal-directed therapy (GDT) was introduced to titrate intravenous fluids, with or without inotropic drugs, based on objective measures of hypovolaemia and cardiac output measurements to improve organ perfusion. This meta-analysis aimed to determine the effect of GDT on the recovery of bowel function after abdominal surgery.

Methods: MEDLINE, Embase, the Cochrane Library and PubMed databases were searched for randomized clinical trials and cohort studies, from January 1989 to June 2013, that compared patients who did, or did not, receive intraoperative GDT, and reported outcomes on the recovery of bowel function. Time to first flatus and first bowel motion, time to tolerate oral diet, postoperative nausea and vomiting, and primary postoperative ileus were included.

Results: Thirteen trials with 1399 patients were included in the analysis. GDT shortened the time to the first bowel motion (weighted mean difference (WMD -0·67, 95 per cent c.i. -1·23 to -0·11; P = 0·020) and time to tolerate oral intake (WMD -0·95, -1·81 to -0·10; P = 0·030), and reduced postoperative nausea and vomiting (risk difference -0·15, -0·26 to -0·03; P = 0·010). When only high-quality studies were included, GDT reduced only the time to tolerate oral intake (WMD -1·18, -2·03 to -0·33; P = 0·006). GDT was more effective outside enhanced recovery programmes and in patients undergoing colorectal surgery.

Conclusion: GDT facilitated the recovery of bowel function, particularly in patients not treated within enhanced recovery programmes and in those undergoing colorectal operations.