Does intra-operative cardiac output monitoring improve outcomes for patients undergoing elective colorectal surgery within an enhanced recovery programme?

Abstract

Aim: Intra-operative cardiac output (CO) monitoring became a standard of care in Northampton General Hospital, UK, at the end of 2013. This study aimed to assess the effectiveness of intra-operative CO monitoring with oesophageal Doppler or LiDCO for patients undergoing elective colorectal surgery for cancer within an enhanced recovery after surgery (ERAS).

Methods: Data was prospectively collected over a 5-year period (March 2010 - Feb 2015) for patients undergoing elective colorectal surgery in the practice of a single surgeon. The ERAS protocol was applied for all the patients. There were 69 patients who had intra-operative CO monitoring with oesophageal Doppler or LiDCO and 144 patients who had no intra-operative CO monitoring. Results were analysed for post-operative outcomes (morbidity, mortality, readmission within 30 days, total length of hospital stay and admission to a high level of care facility).

Results: There was no significant difference in 30-day morbidity and readmission rates between the two examined groups. Forty-six percent of patients in the intra-operative CO monitoring group were admitted to a low level of care facility (ward) in comparison to 24% of patients in the no intra-operative CO monitoring group (P = 0.01).

Conclusion: Using intra-operative CO monitoring singnificantly might reduce the need for admission to critical care. A larger cohort study is needed to further confirm these findings and account for any co-founders.

Keywords

Non-invasive cardiac output monitoring / enhanced recovery / colorectal surgery / outcomes / perioperative care

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