• Alireza Ghoreifi, Michael F Basin, Saum Ghodoussipour, Soroush T Bazargani, Erfan Amini, Mohammad Aslzare, Jie Cai, Gus Miranda, Shihab Sugeir, Sumeet Bhanvadia, Anne K Schuckman, Siamak Daneshmand, Philip Lumb, and Hooman Djaladat.
• Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, USC, 1441 Eastlake Ave. NOR 7416, Los Angeles, CA, 90089, USA.
• Int Urol Nephrol. 2021 Sep 1; 53 (9): 1827-1833.

PurposeThe aim of this study is to evaluate the intra/perioperative fluid management and early postoperative outcomes of patients who underwent radical cystectomy with Enhanced Recovery After Surgery protocol, using goal-directed fluid therapy compared to conventional fluid therapy.MethodsThis cohort study included patients who underwent open RC for urothelial bladder carcinoma with intent to cure and Enhanced Recovery After Surgery protocol between May 2012 and August 2019. Patients who had palliative or salvage cystectomy and/or adjunct procedures, as well as those with missing detailed perioperative data were excluded. Data were compared between patients who received goal-directed fluid therapy using stroke volume variation by FloTrac™/Vigileo system (n = 119) and conventional fluid therapy based on the anesthesiologist discretion (n = 192). Primary outcome variable was 90-day complications and secondary outcome measures included in-hospital GFR trend, length of stay, and 90-day readmission.ResultsThe goal-directed fluid therapy group received less total and net intra/perioperative fluid, yet early postoperative glomerular filtration rate trends were similar between both groups (p = 0.7). Estimated blood loss, blood transfusion, index hospital stay, 90-day complication and readmission rates were also comparable between the two groups. Multivariable logistic regression showed no significant association between perioperative fluid management method and 90-day complication rate (OR 1.4, 95% CI 0.8-2.4, p = 0.2).ConclusionStroke volume variation guided goal-directed fluid therapy is safe in radical cystectomy without compromising the renal function. It is associated with less intra- and perioperative fluid infusion; however, no association with hospital stay, 90-day complication or readmission rates were noted.© 2021. The Author(s), under exclusive licence to Springer Nature B.V.

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