Goal-Directed Fluid Therapy in Autologous Breast Reconstruction allows Less fluid volume and more vasopressor use without outcome compromise

Abstract Objective Aggressive or restricted perioperative fluid management has been shown to increase complications in patients undergoing microsurgery. Goal directed fluid therapy (GDFT) aims to administer fluid, vasoactive agents, and inotropes according to each patient's hemodynamic indices. This study assesses GDFT impact on perioperative outcomes autologous breast reconstruction (ABR) patients. We hypothesize that GDFT will have overall lower fluid administration and equivocal outcomes to patients not on GDFT. Methods A single center retrospective review was conducted on ABR patients from January 2010-April 2017. An enhanced recovery pathway (ERP) using GDFT was implemented in April 2015. With GDFT, patients were administered intraoperative fluids, and vasoactive agents according to hemodynamic indices. Patients prior to April 2015 were considered pre-ERP cohort. Primary outcomes included amount and rate of fluid delivery, urine output (UOP), vasopressor administration, major (i.e. flap failure) and minor (i.e. seroma) complications, and length of stay (LOS). Results Overall, 777 patients underwent ABR (ERP: 312; pre-ERP: 465). ERP patients received significantly less total fluid volume (ERP median: 3750 mL [IQR: 3000–4500 mL]; pre-ERP median: 5000 mL [IQR 4000–6400 mL]; p Conclusions GDFT, as part of an ERP, and prudent use of vasopressors were found to be safe and did not increase morbidity in ABR patients. GDFT provides individualized perioperative care to the ABR patient.