Hemodynamic management and surgical site infection: Network meta-analysis of randomized controlled trials

Xu Zhao; Lina Zhang; Alexandria Brackett; Feng Dai; Junmei Xu; Lingzhong Meng

doi:10.1016/j.jclinane.2020.110021

Hemodynamic management and surgical site infection: Network meta-analysis of randomized controlled trials

J Clin Anesth. 2020 Dec:67:110021. doi: 10.1016/j.jclinane.2020.110021. Epub 2020 Sep 11.

Authors

Xu Zhao¹, Lina Zhang², Alexandria Brackett³, Feng Dai⁴, Junmei Xu⁵, Lingzhong Meng⁶

Affiliations

¹ Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States of America; Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
² Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Huanan Province, China.
³ Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States of America.
⁴ Department of Biostatistics, Yale University School of Public Health, New Haven, CT, United States of America.
⁵ Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China. Electronic address: xujunmei@139.com.
⁶ Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States of America. Electronic address: lingzhong.meng@yale.edu.

PMID: 32927235
DOI: 10.1016/j.jclinane.2020.110021

Abstract

Study objective: To investigate which hemodynamic management strategy is most effective in reducing surgical site infection (SSI).

Design: Network meta-analysis of randomized controlled trials.

Setting: Perioperative setting.

Patients: Surgical patients.

Interventions: Usual care vs. optimized hemodynamic management, including goal-directed hemodynamic therapy (GDHT) and liberal/restrictive fluid therapy.

Measurements: The primary outcome was SSI arising within postoperative 30 days. The secondary outcomes included postoperative respiratory and urinary system infectious complications and sepsis/septic shock. The effect and ranking were assessed using network meta-analysis and the surface under the cumulative ranking curve (SUCRA) scores, respectively.

Main results: We systematically searched Ovid MEDLINE, Ovid Embase, and Web of Science for eligible randomized controlled trials from inception to October 11, 2019. Fifty-three eligible studies reported SSI and comprised of 56 GDHT groups (patients, n = 4205) and 51 usual care groups (patients, n = 3895). Comparing with usual care, GDHTs aimed at intravascular volume and stroke volume optimization (odds ratio (OR), 0.28 [95% credible interval (CrI), 0.13 to 0.56]; moderate quality), stroke volume and cardiac output optimization (OR, 0.34 [95% CrI, 0.16 to 0.70]; moderate quality), and intravascular volume and cardiac output optimization (OR, 0.51 [95% CrI, 0.24 to 0.99]; low quality) significantly reduced SSI. GDHT strategy aimed at intravascular volume and stroke volume optimization was likely most effective (SUCRA = 80%). Certain GDHTs significantly reduced respiratory infectious complications; however, no GDHT significantly reduced urinary infectious complications and sepsis/septic shock. GDHT strategy aimed at intravascular volume, stroke volume, and cardiac output optimization was likely most effective for reducing respiratory infectious complications (SUCRA = 88%).

Conclusions: Different hemodynamic managements exert different effectiveness for SSI reduction. GDHTs aimed at intravascular volume, stroke volume, and cardiac output optimization are likely most effective based on the overall evidence.

Keywords: Goal-directed hemodynamic therapy; Infectious complications, randomized controlled trial; Network meta-analysis; Surgical site infection.

Publication types

Meta-Analysis

MeSH terms

Fluid Therapy
Hemodynamics*
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / prevention & control