Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study.
OBJECTIVE
Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.


METHODS
All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.


RESULTS
Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (p = 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days, p = 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02-1.07), p < 0.0001], randomization to the goal-directed group of the study [HR 0.61 (0.4-0.92), p = 0.02], and avoidance of a significant postoperative cardiac complication [HR 3.78 (2.16-6.6), p = 0.007].


CONCLUSIONS
Long-term survival after major surgery is related to a number of factors, including patient age and avoidance of perioperative complications. Short-term goal-directed therapy in the perioperative period may improve long-term outcomes, in part due to its ability to reduce the number of perioperative complications.
Rhodes
Andrew
A
Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London SW17 0QT, UK. andyr@sgul.ac.uk
Cecconi
Maurizio
M
Hamilton
Mark
M
Poloniecki
Jan
J
Woods
Justin
J
Boyd
Owen
O
Bennett
David
D
Grounds
R Michael
RM
D002985:Clinical Protocols; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006439:Hemodynamics; D006801:Humans; D018802:Patient-Centered Care; D019990:Perioperative Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000534:rehabilitation*; D016019:Survival Analysis