The effect of goal-directed therapy on postoperative infections in high risk surgical patients: a Meta analysis / 中华普通外科杂志

ABSTRACT

ObjectiveTo determine the effects of perioperative hemodynamic goal directed therapy (GDT) on postoperative infection rates. MethodsWe conducted a systematic review and Meta-analysis.MEDLINE,the Cochrane Library,EMBASE,CNKI and other sources were searched until March 2011.All randomized controlled trials (RCTs) on adult major surgical patients managed with perioperative GDT or according to routine haemodynamic practice were included.Primary outcome measure was specific for type of infection. Two authors independently extracted data and assessed study quality using standardized instruments; Consensus was reached by conference.The Cochrance Collaboration's software RevMan 5.0 was used for data analysis. ResultsSixteen studies were included in the final analysis,providing a sample of 3309 patients. Perioperative GDT significantly reduced surgical site infections (SSI)(OR =0.60; 95％CI0.46-0.74; P ＜0.0001),pneumonia (OR =0.69; 95％CI 0.53 -0.90;P =0.007),and urinary tract infections (UTIs) (OR =0.44; 95％ CI 0.22 -0.88; P =0.02),and there was no heterogeneity between studies (P ＞ 0.1,I2 ＜ 50％ ).A significant decrease in total infection episodes was observed (OR=0.37; 95％CI0.22-0.61; P＜0.00001). ConclusionsA flow-directed hemodynamic therapy protects the high-risk surgical patients against postoperative hospital-acquired infections.