title: Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study.
abstract: BACKGROUND
  Goal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome.
  
  
  RESULTS
  We compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT. There was no difference in the proportion of patients with a complication (56% vs. 54%, p = 0.82), hospital stay and mortality. The incidence of prolonged ICU stay (>48 hours) was reduced (28% vs. 12, p = .005) in patients treated with GDT. Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with GDT. Patients in the GDT group received significantly less fluids but received more colloids.
  
  
  CONCLUSIONS
  The implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay. However, we observed a decrease in pneumonia, mediastinal abscesses, gastric tube necrosis, and ICU length of stay.
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Denise P
authors.initials: DP
authors.lastname: Veelo
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kirsten S
authors.initials: KS
authors.lastname: Ouwehand
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Bart F
authors.initials: BF
authors.lastname: Geerts
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Maarten C J
authors.initials: MC
authors.lastname: Anderegg
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: van Dieren
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Preckel
authors.affiliation: Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Suzanne S
authors.initials: SS
authors.lastname: Gisbertz
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology; D016629:Esophagectomy / Q000009:adverse effects; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006040:Goals; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D058996:Quality Improvement
chemical_list: D000890:Anti-Infective Agents