title: Haemodynamic goal-directed therapy and postoperative infections: earlier is better. A systematic review and meta-analysis.
abstract: BACKGROUND
  Infectious complications are the main causes of postoperative morbidity. The early timing of their promoting factors is the rationale for perioperative strategies attempting to reduce them. Our aim was to determine the effects of perioperative haemodynamic goal-directed therapy on postoperative infection rates.
  
  
  METHODS
  We performed a systematic review and meta-analysis. MEDLINE, EMBASE, The Cochrane Library and the DARE databases were searched up to March 2011. Randomised, controlled trials of major surgery in adult patients managed with perioperative goal-directed therapy or according to routine haemodynamic practice were included. Primary outcome measure was specific type of infection.
  
  
  RESULTS
  Twenty-six randomised, controlled trials with a combined total of 4,188 participants met our inclusion criteria. Perioperative goal-directed therapy significantly reduced surgical site infections (pooled OR 0.58, 95% CI 0.46 to 0.74; P < 0.0001), pneumonia (pooled OR 0.71, 95% CI 0.55 to 0.92; P = 0.009), and urinary tract infections (pooled OR 0.44, 95% CI 0.22 to 0.84; P = 0.02). A significant benefit was found regarding total infectious episodes (OR 0.40, 95% CI 0.28 to 0.58; P < 0.00001).
  
  
  CONCLUSIONS
  Flow-directed haemodynamic therapy designed to optimise oxygen delivery protects surgical patients against postoperative hospital-acquired infections and must be strongly encouraged, particularly in the high-risk surgical population.
authors.affiliation: Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza G, Cesare 11, I-70124 Bari, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Dalfino
authors.forename: Maria T
authors.initials: MT
authors.lastname: Giglio
authors.forename: Filomena
authors.initials: F
authors.lastname: Puntillo
authors.forename: Massimo
authors.initials: M
authors.lastname: Marucci
authors.forename: Nicola
authors.initials: N
authors.lastname: Brienza
mesh_terms: D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D010347:Patient Care Planning / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome