Intensive Care Medicine

, Volume 36, Issue 8, pp 1327–1332

Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study

  • Andrew Rhodes
  • Maurizio Cecconi
  • Mark Hamilton
  • Jan Poloniecki
  • Justin Woods
  • Owen Boyd
  • David Bennett
  • R. Michael Grounds
Original

DOI: 10.1007/s00134-010-1869-6

Cite this article as:
Rhodes, A., Cecconi, M., Hamilton, M. et al. Intensive Care Med (2010) 36: 1327. doi:10.1007/s00134-010-1869-6

Abstract

Purpose

Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.

Methods

All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.

Results

Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (p = 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days, p = 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02–1.07), p < 0.0001], randomization to the goal-directed group of the study [HR 0.61 (0.4–0.92), p = 0.02], and avoidance of a significant postoperative cardiac complication [HR 3.78 (2.16–6.6), p = 0.007].

Conclusions

Long-term survival after major surgery is related to a number of factors, including patient age and avoidance of perioperative complications. Short-term goal-directed therapy in the perioperative period may improve long-term outcomes, in part due to its ability to reduce the number of perioperative complications.

Keywords

Long term outcome Surgery Hemodynamics 

Supplementary material

134_2010_1869_MOESM1_ESM.doc (164 kb)
Supplementary material 1 (DOC 164 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Andrew Rhodes
    • 1
  • Maurizio Cecconi
    • 1
  • Mark Hamilton
    • 1
  • Jan Poloniecki
    • 2
  • Justin Woods
    • 1
  • Owen Boyd
    • 3
  • David Bennett
    • 1
  • R. Michael Grounds
    • 1
  1. 1.Department of Intensive Care MedicineSt George’s Healthcare NHS TrustLondonUK
  2. 2.Department of Medical StatisticsSt George’s University of LondonLondonUK
  3. 3.Department of Intensive Care MedicineBrighton and Sussex University Hospitals NHS TrustLondonUK