None listed
Conditions
Brief summary
Right hepatectomy involves removal of a significant amount of liver parenchymal tissue and a lot of planning is required to ensure avoiding the inherent risks of major haemorrhage and severe hypotension. Over the last two decades, there have been the development of Enhanced Recovery After Surgery (ERAS) programmes particular for liver resections, aimed at reducing overall morbidity and length of hospital stay. . The traditional approach at Austin health focuses on “restrictive” fluid therapy, guided by “low central venous pressure anaesthesia” during liver resections. A second approach has been developed, which uses a surgery-specific cardiac output-guided algorithm for patients undergoing complex liver resection. This algorithm has been modified from another algorithm that has been used for pancreatic surgery. The aim of the study is to evaluate the two fluid intervention strategies and their differences in the use of intraoperative fluid, vasoactive medications, post-operative complications and hospital length of stay. This is a retrospective observational study that looked at patients undergoing major right hepatectomy with usual care or “traditional” restrictive fluid therapy & low CVP anaesthesia, compared to those who were managed with the surgery-specific cardiac output algorithm. It is hypothesised that the surgery-specific cardiac output-guided algorithm improves length of hospital stay and reduces morbidity and post-operative complications in major right hepatectomy.
Interventions
This retrospective observational study will include the records of patients who have undergone right hepatectomy and received either traditional fluid intervention practice (i.e. fluid restriction and low central venous pressure anaesthesia) or Goal Directed Therapy (GDT). Both groups of patients have received a dedicated enhanced recovery after surgery (ERAS) program.
Goal-directed therapy utilizes monitoring techniques to help guide clinicians with administering fluids, vasopressors, inotr
This retrospective observational study will include the records of patients who have undergone right hepatectomy and received either traditional fluid intervention practice (i.e. fluid restriction and low central venous pressure anaesthesia) or Goal Directed Therapy (GDT). Both groups of patients have received a dedicated enhanced recovery after surgery (ERAS) program. Goal-directed therapy utilizes monitoring techniques to help guide clinicians with administering fluids, vasopressors, inotropes, or other treatments to patients in various clinical settings. In our centre, the device we utilise for GDT is a FloTrac™ catheter (FloTrac System 4.0, Edwards Lifesciences, Irvine, CA, USA). This is attached to the participant’s arterial line and then connected to an EV1000 haemodynamic monitor (Edwards Lifesciences, Irvine, CA, USA). Data from this technology provides real time measurements of continuous blood pressure, cardiac and stroke volume index, stroke volume variation and systemic vascular resistance. Specific to patients undergoing major liver resection, we target a stroke volume variation of greater than 20% was used as a threshold for fluid intervention during the dissection and hepatic transection stages. During haemostasis and surgical closure, a stroke volume variation of greater than 15% is used as a fluid intervention target for restoration of euvolemia. The ERAS program consists of avoidance of nasogastric tubes, early mobilisation with physiotherapy on the day of surgery, early free fluids (within two postoperative hours), early oral intake (within 6 postoperative hours), optimising analgesia with a dedicated acute pain team service), prophylactic use of anti-emetics, antibiotic prophylaxis, chemothrombotic prophylaxis, and daily postoperative physiotherapy. We aim to compare impact of GDT group has on patients length of hospital stay, fluid use intraoperatively and post operatively, use of vasoactive drugs intraoperatively, and all post operative complications. Patients will not be contacted in any way, and all information extracted from the records will be de-identified and aligned with hospital governance processes for clinical audit and retrospective data collection.
Sponsors
Austin Hospital
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
All patients (age >18 years) undergoing right hepatectomy with a standard ERAS (enhanced recovery after surgery) protocol.
Exclusion criteria
1. Age less than 18 years 2. Patients who did not receive ERAS liver protocol prior to surgery 3. Patients undergoing left hepatectomy, minor resections, non-anatomy segemental reseections and wedge resections
Outcome results
None listed