title: The role of intraoperative fluid optimization using the esophageal Doppler in advanced gynecological cancer: early postoperative recovery and fitness for discharge.
abstract: OBJECTIVE
  To determine the effect of fluid optimization using esophageal Doppler monitoring (EDM) when compared to standard fluid management in women who undergo major gynecological cancer surgery and whether its use is associated with reduced postoperative morbidity.
  
  
  METHODS
  From January 2009 to December 2010, women undergoing laparotomy for pelvic masses or uterine cancer had either fluid optimization using intraoperative EDM or standard fluid replacement without using EDM. Cases were selected from 2 surgeons to control for variability in surgical practice. Demographic and surgical details were collected prospectively. Univariate and multivariate analyses were performed to quantify the association between the use of EDM with "early postoperative recovery" and "early fitness for discharge."
  
  
  RESULTS
  A total of 198 women were operated by the 2 prespecified surgeons; 79 women had fluid optimization with EDM, whereas 119 women had standard anesthetic care. The use of ODM was associated with earlier postoperative recovery (adjusted odds ratio, 2.83; 95% confidence interval, 1.20-6.68; P = 0.02) and earlier fitness for discharge (adjusted odds ratio, 2.81; 95% confidence interval, 1.01-7.78; P = 0.05). Women with advanced-stage disease in the "EDM" group resumed oral diet earlier than women in the "no EDM" group (median, 1 day vs 2 days; P = 0.02). These benefits with EDM did not extend to women with early-stage disease/benign/borderline tumors. No significant difference in postoperative complications was noted.
  
  
  CONCLUSIONS
  Intraoperative fluid optimization with EDM in women with advanced gynecological cancer may be associated with improved postoperative recovery and early fitness for discharge. Studies with adequate power are needed to investigate its role in reducing postoperative complications.
authors.affiliation: Northern Gynaecological Oncology Centre (NGOC), Queen Elizabeth Hospital, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, UK. s.chattopadhyay@ghnt.nhs.uk
authors.forename: Supratik
authors.initials: S
authors.lastname: Chattopadhyay
authors.forename: Shilpi
authors.initials: S
authors.lastname: Mittal
authors.forename: Steven
authors.initials: S
authors.lastname: Christian
authors.forename: Andries Lourens
authors.initials: AL
authors.lastname: Terblanche
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Ioannis
authors.initials: I
authors.lastname: Biliatis
authors.forename: Ali
authors.initials: A
authors.lastname: Kucukmetin
authors.forename: Raj
authors.initials: R
authors.lastname: Naik
authors.forename: Khadra
authors.initials: K
authors.lastname: Galaal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002138:Calibration; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000592:standards*; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods* / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010809:Physical Fitness / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D011997:Recovery Room / Q000706:statistics & numerical data; D018608:Ultrasonography, Doppler