Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program.

BACKGROUND AND AIMS: The Enhanced Recovery after Surgery (ERAS) program has been proposed as a postoperative recovery-enhancing strategy. We frequently apply the Modified-ERAS program following oesophagectomy. This study aims to elucidate the impact of goal-directed fluid therapy (GDT) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy. METHODS: This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre, Japan. Patients who underwent elective oesophagectomy for oesophageal cancer were recruited. Group H (retrospectively collected) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program, while Group S prospectively received management consisting of GDT and the M-ERAS program. The primary endpoint was the speed of gastrointestinal functional recovery, while secondary endpoints were the level of postoperative mobilisation, incidence of complications, postoperative length of hospital stay (LOS), and nutritional status after discharge. RESULTS: The proportion of patients who completely egested Gastrografin by postoperative day 4, the level of postoperative mobilisation, and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H (P = 0.034, P = 0.0197, and P < 0.0001, respectively). No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups. The serum albumin levels at 6 months after discharge was higher in Group S than in Group H (P = 0.0002). CONCLUSIONS: The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation, as well as postoperative nutritional status and protein synthesis. The program did not affect either postoperative LOS or the incidence of complications. TRIAL REGISTRATION: UMIN registration number: UMIN000013705, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999.

The development of a pre-dehydration check sheet for independent community dwelling elderly. -A continuation of research about pre-dehydration among elderly individuals who had been admitted to or regularly visited an elderly-care institution.

AIM: In the present study, we defined the state of pre-dehydration (PD) as the suspected loss of body fluids, not accompanied by subjective symptoms (serum osmotic pressure: 292-300 mOsm/kg・H2O). The goal of this study was to develop a non-invasive PD check sheet for independent home care for the elderly. METHODS: We evaluated the serum osmotic pressure of 222 independent community dwelling elderly individuals who were >65 years of age. We then determined the association between the serum osmotic pressure and various dehydration-related diagnostic factors that we identified in a previous study. We performed a logistic regression analysis to determine the risk factors for dehydration and allotted scores based on the odds ratio. We developed a non-invasive PD check sheet consisting of items with high scores and categorized the risks based on the positive predictive value of the total score of the applied items. RESULTS: PD was confirmed in 46 subjects (20.7%) based on their serum osmotic pressure. We developed a PD assessment sheet which consisted of 6 items, (1) Dislike rehydrating before sleeping, as it induces the need to use the toilet (3 points), (2) Using diuretics (8 points), (3) Casual blood sugar ≥126 mg/dl (9 points), (4) Age ≥85 years (3 points), (5) Male sex (4 points), (6) Body weight ≥60 kg (3 points). Patients with a score of >13 points on this sheet were considered to have a high risk of PD (maximum score: 30 points) (positive predictive value, 72%; negative predictive value, 85.6%; P<0.0001). CONCLUSION: In the present study, we found that 20.7% of elderly subjects had PD. Based on these data, we developed an effective noninvasive tool for detecting PD among independent community dwelling elderly.