The Effects of Intraoperative Goal-Directed Fluid Therapy in the Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Goal-directed fluid therapy (GDFT) has been proposed to optimize fluid management and reduce perioperative complications in the elderly. This meta-analysis evaluates the effects of intraoperative GDFT compared to conventional fluid therapy (CFT) on postoperative outcomes in elderly surgical patients. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, randomized controlled trials (RCTs) were identified from six databases. Outcomes assessed included overall postoperative complications, 30-day mortality, hospital length of stay (LOS), and total fluid administered. Ten RCTs met the inclusion criteria, of which nine (n = 1,001) were included in the quantitative synthesis after excluding studies employing outdated protocols. GDFT significantly reduced overall complication rates (risk ratios [RR] = 0.80 [95% confidence interval (CI): 0.69-0.92]; P = 0.002), LOS (mean difference [MD] = -1.31 days [95% CI: -2.55 to -0.07]; P = 0.04), and intraoperative fluid volume (MD = -258.74 mL [95% CI: -450.86 to -66.68]; P = 0.008) compared to CFT. GDFT was also associated with lower 30-day mortality (RR = 0.42 [95% CI: 0.17-1.04]), though not statistically significant (P = 0.06). Substantial heterogeneity was noted for LOS and fluid volume. Subgroup analysis had no impact on LOS but decreased heterogeneity in intraoperative volume, with significant fluid-sparing effects only in the gastrointestinal surgery subgroup. Sensitivity analyses further revealed that the exclusion of specific studies influenced the results for mortality and LOS. In conclusion, when compared with CFT, intraoperative GDFT offers benefits in reducing postoperative complications, hospital stay, and fluid use in elderly patients. Further research is necessary to optimize protocols and address the observed heterogeneity.