wetenschapsdag 2023 | 47 Sessie 1d: Een Goede Fundering Voor de Chirurgische Lering 1 Auteurs H. Jalalzadeh, R.H. Hulskesc, R. P Weenink, D. Veelo, N. Wolfhagen, M.W. Hollmann, M.A. Boermeester, S.W. de Jonge Abstract titel Systematic review and meta-analysis of hemodynamic management strategies during surgery for the prevention of surgical-site infection and other postoperative outcomes Background Surgical site infection (SSI) is the most common postoperative complication. A recent meta-analysis evaluating perioperative goaldirected fluid therapy (GDFT) suggests low certainty of evidence for its beneficial impact on SSI. However, this was a secondary endpoint in a systematic review on mortality and important data on SSI were not included. We assessed the influence of GDFT on SSI and other postoperative outcomes. Methods We searched MEDLINE and Embase for randomised controlled trials comparing the effect of any GDFT algorithm to conventional fluid therapy on SSI incidence in adult patients undergoing surgery, published up to August 3, 2023. We conducted sensitivity analyses based on risk of bias and subgroup analyses based on high-risk target populations, early timing of GDFT, GDFT algorithms using a combination of fluids, vasopressors and inotropes, presence of a target variable and personalised target variables. Trial sequential analysis (TSA) was performed to assess the risk of random error and the potential need for additional data. We evaluated the certainty of evidence using GRADE. Results The search resulted in 1451 articles, whereof 68 studies were included. The incidence of SSI was 11.6% (1,300 of 11,255 patients). The pooled relative risk of SSI was 0.68 (95% CI 0.60 - 0.79) after GDFT. Sensitivity analyses of studies with a low risk of bias did not change the overall effect. Meta-regression indicated no individual subgroup was associated with the outcome. In the TSA, the cumulative z-line crossed the boundary for effect, indicating that new RCTs are unlikely to modify the effect estimate. Conclusion Moderate certainty evidence indicates that GDFT helps prevent SSI when compared to conventional fluid therapy in adults undergoing surgery and new RCTs are unlikely to change this outcome. Guidelines should be updated to reflect this.
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