Abstract
Background
Major lumber spine surgeries in the prone position have high mortality and morbidity, especially in elderly patients. Intraoperative goal-directed fluid therapy (GDT) has improved outcomes in abdominal and thoracic surgical procedures. However the utility of intraoperative GDT in spine surgery has not been present. In this study, we investigated whether GDT would reduce the postoperative complications in elderly patients undergoing lumbar stenosis decompression in the prone position.
Methods
In this single-center, randomized controlled clinical trial, we randomly assigned 84 patients aged > 60 undergoing lumbar decompression surgery to either a GDT group or a control group, who received conventional anesthesiologist-directed fluid therapy. Perioperative lactic acid concentrations with 7 different time point, intraoperative fluid balance and postoperative complications from admittance to 30 days after surgery were recorded.
Results
Lactic acid concentrations were higher in the control group than in the GTD group from the start of operation to 24 h after the operation, reaching maximum concentrations at exit from the post-anesthesia care unit (2.50 ± 1.22 mmol/l compared with 1.32 ± 0.42 mmol/l in controls; p<0.001). More total fluid volume was infused in GDT patients than in control patients (2416 ± 539 ml vs. 2036 ± 424ml, p<0.001). GDT patients had fewer infectious complications that did control patients (4.7% vs. 19.5%, P<0.001) after the surgery.
Conclusion
GDT during lumbar decompressive surgery under general anesthesia in elderly patients results in significantly better postoperative outcomes, which may be due to optimal fluid management and better perfusion of tissues and organs.
Trial registration
NCT02470221. Initial registration date was 06/09/2015.
Multidisciplinary Nutrition Management Based on Enhanced Recovery after Surgery Protocols in Patients Undergoing Percutaneous Endoscopic Interlaminar Discectomy: A Randomized Controlled Clinical Trial
