Optimal fluid management during major abdominal surgery remains a cornerstone of perioperative care, influencing both short-term recovery and long-term outcomes. The traditional approach to intraoperative fluid administration often relies on static parameters and fixed fluid regimens, which may lead to either fluid overload or inadequate perfusion. These deviations from optimal volume status have been associated with increased rates of postoperative complications such as surgical site infections, delayed gastrointestinal recovery, and prolonged hospital stays (1,2).

Goal-Directed Fluid Therapy (GDFT) has emerged as a dynamic and individualized strategy that utilizes real-time hemodynamic monitoring to guide fluid administration. By targeting specific endpoints such as stroke volume variation (SVV), cardiac output, and mean arterial pressure, GDFT aims to optimize tissue perfusion and oxygen delivery while avoiding the harmful effects of fluid imbalance (3,4). Several studies have reported that GDFT may reduce postoperative morbidity, improve recovery profiles, and shorten hospital stays in high-risk surgical patients (5-7).

Despite growing evidence supporting GDFT, its application in routine surgical practice remains variable, particularly in resource-limited settings. Furthermore, while randomized trials have demonstrated its benefits, real-world observational data are still limited. This study was therefore undertaken to assess the impact of intraoperative GDFT on postoperative outcomes in patients undergoing major abdominal surgeries, using a prospective observational design in a tertiary care setting.

A total of 80 adult patients aged between 18 and 70 years, scheduled for elective major abdominal surgery under general anesthesia, were included. Patients with significant cardiac dysfunction (ejection fraction <40%), chronic renal failure, ongoing sepsis, or emergency surgeries were excluded.

Study Groups and Intervention:

Participants were allocated into two groups based on the intraoperative fluid management approach employed by the attending anesthesiologist:

• Group A (GDFT Group): Patients received Goal-Directed Fluid Therapy guided by dynamic parameters such as stroke volume variation (SVV) and cardiac output, measured via a minimally invasive hemodynamic monitor (e.g., FloTrac/Vigileo system). Fluid boluses were administered in 200–250 mL increments if SVV exceeded 13%, and vasopressors were used as needed to maintain target mean arterial pressure (MAP ≥65 mmHg).
• Group B (Conventional Group): Patients received standard fluid therapy based on fixed infusion rates and static parameters like heart rate, blood pressure, and urine output. No advanced hemodynamic monitoring was employed.

Anesthesia and Monitoring:

All patients were premedicated and induced using a standardized protocol. General anesthesia was maintained with a combination of volatile agents, opioids, and neuromuscular blockers. Standard intraoperative monitoring included ECG, pulse oximetry, capnography, invasive blood pressure, and core temperature. In the GDFT group, advanced hemodynamic monitoring devices were used continuously throughout the surgery.

Data Collection and Outcomes:

Intraoperative data collected included total fluid volume administered, vasopressor usage, blood loss, and duration of surgery. Postoperative data comprised the incidence of complications (pulmonary complications, ileus, surgical site infections), time to return of bowel function, length of ICU stay, and total hospital stay. Patients were followed for 7 days postoperatively or until discharge.

Statistical Analysis:

Data were analyzed using SPSS software version 25.0. Continuous variables were expressed as mean ± standard deviation and compared using the independent t-test or Mann-Whitney U test, depending on data distribution. Categorical variables were presented as frequencies and percentages, and analyzed using the chi-square or Fisher's exact test. A p-value of less than 0.05 was considered statistically significant.

A total of 80 patients undergoing major abdominal surgery were included in the study and divided equally into two groups: Group A (Goal-Directed Fluid Therapy; n=40) and Group B (Conventional Fluid Therapy; n=40). Both groups were comparable in terms of demographic variables such as age, sex, and ASA physical status, with no statistically significant differences (p > 0.05) (Table 1).

Intraoperative Parameters:

The mean volume of crystalloids administered intraoperatively was significantly lower in Group A (2400 ± 300 mL) compared to Group B (3100 ± 400 mL), (p < 0.001). Blood loss was slightly lower in Group A (480 ± 120 mL) versus Group B (520 ± 130 mL), but this was not statistically significant (p = 0.09). The use of vasopressors was higher in the GDFT group (60%) than in the conventional group (45%), indicating adherence to hemodynamic targets in the former (Table 2).

Postoperative Outcomes:

Group A demonstrated significantly better postoperative outcomes. The incidence of postoperative ileus was reduced to 10% in Group A, compared to 25% in Group B (p = 0.04). Pulmonary complications occurred in 2 patients (5%) in Group A versus 7 patients (17.5%) in Group B (p = 0.03). The average ICU stay was shorter in Group A (1.8 ± 0.6 days) than in Group B (3.1 ± 1.1 days) (p = 0.001). Furthermore, the median return of bowel function was earlier in Group A (2 days) compared to Group B (3.5 days) (p < 0.01), and overall hospital stay was also reduced by approximately 2.5 days (Table 3).

Table 1: Baseline Characteristics of the Study Population

Table 2: Intraoperative Parameters

Table 3: Postoperative Outcomes

As illustrated in Tables 2 and 3, patients managed with Goal-Directed Fluid Therapy experienced more favorable outcomes in terms of fluid balance, complication rates, and recovery times when compared to those managed with conventional fluid strategies.

The findings of this prospective observational study support the growing body of evidence that Goal-Directed Fluid Therapy (GDFT) offers significant clinical benefits over conventional fluid management strategies in major abdominal surgeries. Patients managed with GDFT had lower rates of postoperative complications, faster return of bowel function, and shorter ICU and hospital stays, underscoring the importance of individualized fluid optimization in perioperative care.

Intraoperative fluid therapy has a direct influence on tissue perfusion and postoperative recovery. Traditional liberal or restrictive fluid strategies may fail to address real-time physiological demands, potentially resulting in adverse outcomes such as tissue edema, impaired wound healing, or organ dysfunction (1,2). GDFT, by contrast, utilizes dynamic hemodynamic parameters like stroke volume variation (SVV) and cardiac output to guide precise fluid administration, thereby optimizing preload and ensuring adequate perfusion without fluid overload (3,4).

Our results align with previous studies that have demonstrated improved outcomes with GDFT in major abdominal surgeries. Gan et al. reported a significant reduction in hospital stay when intraoperative fluids were guided by stroke volume changes (5). Similarly, the OPTIMISE trial emphasized the benefit of early hemodynamic optimization in reducing gastrointestinal and pulmonary complications in high-risk patients (6). A multicenter randomized trial by Calvo-Vecino et al. also found fewer postoperative complications in patients receiving GDFT (7).

The reduction in postoperative ileus and earlier return of bowel function observed in our GDFT group may be attributed to the maintenance of gut perfusion and avoidance of interstitial edema, which are commonly associated with excessive fluid administration (8,9). Moreover, a shorter ICU stay and hospital stay observed in our study can reduce healthcare costs and resource utilization, supporting findings from prior economic analyses of GDFT implementation (10,11).

While vasopressor use was higher in the GDFT group, it reflects the strategy of combining fluid and pharmacologic agents to maintain optimal perfusion pressures, rather than relying solely on fluid boluses. This multimodal approach has been shown to maintain hemodynamic targets more effectively and safely than fluid loading alone (12,13).

Despite these benefits, the adoption of GDFT in routine practice remains inconsistent, often due to perceived complexity, cost of monitoring devices, and lack of training (14). However, recent advances in non-invasive and minimally invasive monitoring systems are making GDFT more accessible and feasible in various clinical settings (15).

Limitations:
This study was observational and limited to a single center, which may affect the generalizability of the results. Additionally, the choice of fluid strategy was based on anesthesiologist preference rather than randomization, introducing potential bias. Future randomized controlled trials with larger sample sizes are warranted to validate these findings further.

Our study reinforces the clinical value of intraoperative Goal-Directed Fluid Therapy in enhancing recovery and minimizing postoperative complications in patients undergoing major abdominal surgery. Wider implementation of GDFT protocols, supported by appropriate training and equipment, could contribute significantly to improved surgical outcomes

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