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Outcome impact of hemodynamic and depth of anesthesia monitoring during major cancer surgery: a before–after study

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Abstract

Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure > 65 mmHg, stroke volume variation < 12%, cardiac index > 2.5 l min−1 m−2, central venous oxygen saturation > 70%, 40 < bispectral index < 60) for open abdominal cancer surgeries > 2 h. Pre-, intra-, and post-operative data were collected from our electronic medical record database and compared before (March–August 2013) and after (March–August 2014) guideline implementation. A total of 596 patients were studied, 313 before (Before group) and 283 after (After group) guideline implementation. The two groups were comparable for age, ASA score, physiological P-POSSUM score, and surgery duration, but the operative P-POSSUM score was higher in the after group (20 vs. 18, p = 0.009). The use of cardiac output, central venous oxygen saturation and DOA monitoring increased from 40 to 61%, 20 to 29%, and 60 to 88%, respectively (all p-values < 0.05). Intraoperative fluid volumes decreased (16.0 vs. 14.5 ml kg−1 h−1, p = 0.002), whereas the use of inotropes increased (6 vs. 11%, p = 0.022). Postoperative delirium (16 vs. 8%, p = 0.005), urinary tract infections (6 vs. 2%, p = 0.012) and median hospital length of stay (9.6 vs. 8.8 days, p = 0.032) decreased. In patients undergoing major open abdominal surgery for cancer, despite an increase in surgical risk, the implementation of guidelines with predefined targets for hemodynamic and DOA monitoring was associated with a significant improvement in postoperative outcome.

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Acknowledgements

We thank Desiree Chappell, Louisville, KY, for English editing.

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Authors and Affiliations

  1. Department of Anesthesiology, A.C. Camargo Cancer Center, Rua Antonio Prudente, 211, São Paulo, Brazil

    Mariana F. Lima, Luiz Antonio Mondadori, Aline Y. Chibana, Daniel B. Gilio & Eduardo Henrique Giroud Joaquim

  2. Department of Anesthesiology, Universidade Federal de São Paulo, São Paulo, Brazil

    Mariana F. Lima & Eduardo Henrique Giroud Joaquim

  3. MiCo, Denens, Switzerland

    Frederic Michard

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Contributions

All authors participated in the study design and in the interpretation of data. MFL and LAM were involved in data collection and data analysis. MFL and FM drafted the manuscript, and all authors contributed to and approved the final version.

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Correspondence to Mariana F. Lima.

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MFL, LAM and DBG have no conflict of interest to declare. AYC is the president of Fundação para Segurança do Paciente, a non-profit organization to improve patient safety. EHGJ is a member of the speakers’ bureau for Edwards Lifesciences. FM is the managing director of MiCo, a Swiss consulting firm specialized in medical e-nnovations.

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Lima, M.F., Mondadori, L.A., Chibana, A.Y. et al. Outcome impact of hemodynamic and depth of anesthesia monitoring during major cancer surgery: a before–after study. J Clin Monit Comput 33, 365–371 (2019). https://doi.org/10.1007/s10877-018-0190-8

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