Impact of Goal-Directed Fluid Therapy on Postoperative Outcomes in Colorectal Surgery: An Evidence-Based Review

Published:February 27, 2023DOI:



      To investigate the effects of goal-directed fluid therapy (GDFT) or conventional fluid therapy (CFT) in improving postoperative outcomes in patients undergoing colorectal surgeries.


      Evidence-Based Review.


      Following the guidelines outlined in the PRISMA statement, a comprehensive search was conducted using PubMed, Elsevier ScienceDirect, Oxford Academic, EBSCO, Google Scholar, Cochrane Library, and gray literature. Only randomized controlled studies and pre-appraised evidence such as systematic review with meta-analysis examining the effects of GDFT and CFT in colorectal surgery were included. The quality appraisal of the literature was conducted using the proposed algorithm described in the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide.


      Two systematic reviews with meta-analyses and four randomized controlled trials (RCT) involving 2018 patients were included in this review. Overall, the use of GDFT did not shorten the hospital length of stay (LOS), reduce 30–day mortality, lower overall morbidity rates, or decrease incidence of postoperative ileus. Additionally, the return of bowel function was not improved using GDFT or CFT. However, when GDFT was implemented within enhanced recovery after surgery (ERAS) programs, there was a significant reduction in hospital LOS. . When GDFT was used in a non-ERAS patient care setting, there was a significant reduction in overall morbidity rate and faster time to first flatus. All studies included in the review were categorized as Level I and rated Grade A, implying strong confidence in the true effects of GDFT on all outcome measures in the review.


      The benefits of GDFT in colorectal surgery are still unclear. Considerable heterogeneity based on the types of GDFT devices, patient outcome parameters, and fluid protocols limit the application to clinical practice. Furthermore, there was limited data on the effects of GDFT in high-risk patients for colorectal surgery.


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        • U.S. Cancer Statistics Working Group. U.S
        Cancer Statistics Data Visualizations Tool, based on 2020 submission data (1999-2018): U.S.
        Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, 2021 (released in JuneAccessed May 21, 2022)
      1. Colorectal Cancer Information | Understanding Colorectal Cancer. American Cancer Society. Published 2022. Accessed May 21, 2022.

        • Aydemir M
        • Asgarpour H.
        Effects of mechanical bowel preparation on physiological parameters of patients undergoing elective colorectal surgery: a quasi-experimental hospital-based study.
        Intl JCaring Sci. 2020; 13: 73-80
        • Windpessl M
        • Schwarz C
        • Wallner M.
        Bowel prep hyponatremia– a state of acute water intoxication facilitated by low dietary solute intake: case report and literature review.
        BMC Nephrol. 2017; 18: 54
        • Thiele R
        • Raghunathan K
        • Brudney C
        • et al.
        American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery.
        Perioper Med (Lond). 2016; 5: 24
        • Minto G
        • Scott M
        • Miller T.
        Monitoring needs and goal-directed fluid therapy within an enhanced recovery program.
        Anesthesiol Clin. 2015; 33: 35-49
        • Güenaga K
        • Matos D
        • Wille-Jørgensen P.
        Mechanical bowel preparation for elective colorectal surgery.
        Cochrane Database Syst Rev. 2011; 2011CD001544
        • Bhat A
        • Parray F
        • Chowdri N
        • et al.
        Mechanical bowel preparation versus no preparation in elective colorectal surgery: a prospective randomized study.
        Int J Surg Open. 2016; 2: 26-30
        • Holte K
        • Nielsen K
        • Madsen J
        • Kehlet H.
        Physiologic effects of bowel preparation.
        Dis Colon Rectum. 2004; 47: 1397-1402
        • Brandstrup B
        • Tønnesen H
        • Beier-Holgersen R
        • et al.
        Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens.
        Ann Surg. 2003; 238: 641-648
        • Doherty M
        • Buggy DJ.
        Intraoperative fluids: how much is too much?.
        Br J Anaesth. 2012; 109: 69-79
        • Holte K
        • Foss N
        • Andersen J
        • et al.
        Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study.
        Br J Anaesth. 2007; 99: 500-508
        • Bundgaard-Nielsen M
        • Secher NH
        • Kehlet H
        ”Liberal” vs “restrictive” perioperative fluid therapy—a critical assessment of the evidence.
        Acta Anaesthesiol Scand. 2009; 53: 843-851
        • Nisanevich V
        • Felsenstein I
        • Almogy G
        • Weissman C
        • Einav S
        • Matot I.
        Effect of intraoperative fluid management on outcome after intraabdominal surgery.
        Anesthesiology. 2005; 103: 25-32
        • Arkiliç C
        • Taguchi A
        • Sharma N
        • et al.
        Supplemental perioperative fluid administration increases tissue oxygen pressure.
        Surgery. 2003; 133: 49-55
        • Thacker J
        • Mountford W
        • Ernst F
        • Krukas M
        • Mythen M.
        Perioperative fluid utilization variability and association with outcomes.
        Ann Surg. 2016; 263: 502-510
        • Shin C
        • Long D
        • McLean D
        • et al.
        Effects of intraoperative fluid management on postoperative outcomes.
        Ann Surg. 2018; 267: 1084-1092
        • Gustafsson U
        • Scott M
        • Hubner M
        • et al.
        Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS ) Society recommendations: 2018.
        World J Surg. 2019; 43: 659-695
        • Yates D
        • Davies S
        • Milner H
        • Wilson R.
        Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery.
        Br J Anaesth. 2014; 112: 281-289
        • Kendrick J
        • Kaye A
        • Tong Y
        • et al.
        Goal-directed fluid therapy in the perioperative setting.
        J Anaesthesiol Clin Pharmacol. 2019; 35: 29
        • Huang Y
        • Yin K
        • Zhang X
        • Peng M.
        Is goal-directed fluid therapy beneficial for gastrointestinal surgery within an enhanced recovery program? A systematic review and meta-analysis.
        Signa Vitae. 2020; 17: 225-233
        • Zhang X
        • Zheng W
        • Chen C
        • et al.
        Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery.
        Medicine (Baltimore). 2018; 97: e13097
        • Rollins K
        • Lobo D.
        Intraoperative goal-directed fluid therapy in elective major abdominal surgery.
        Ann Surg. 2016; 263: 465-476
        • Trinooson C
        • Gold M.
        Impact of goal-directed perioperative fluid management in high-risk surgical procedures: a literature review.
        AANA J. 2013; 81: 357-368
        • Page MJ
        • McKenzie JE
        • Bossuyt PM
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Wan X
        • Wang W
        • Liu J
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        BMC Med Res Methodol. 2014; 14: 135
        • Dang D
        • Dearholt S.
        Johns Hopkins Nursing Evidence-Based Practice.
        3rd ed. Sigma Theta Tau International, Indianapolis, IN2017
        • Rollins K
        • Mathias N
        • Lobo D.
        Meta-analysis of goal-directed fluid therapy using transoesophageal Doppler monitoring in patients undergoing elective colorectal surgery.
        BJS Open. 2019; 3: 606-616
        • Xu C
        • Peng J
        • Liu S
        • et al.
        Goal-directed fluid therapy vs conventional fluid therapy in colorectal surgery: a meta analysis of randomized controlled trials.
        Int J Surg. 2018; 56: 264-273
        • Lee K
        • Yoo Y
        • Cho J
        • Lee W
        • Kim J
        • Kim M.
        The effect of intraoperative fluid management according to stroke volume variation on postoperative bowel function recovery in colorectal cancer surgery.
        J Clin Med. 2021; 10: 1857
        • Cesur S
        • Çardaközü T
        • Kuş A
        • Türkyılmaz N
        • Yavuz Ö.
        Comparison of conventional fluid management with PVI-based goal-directed fluid management in elective colorectal surgery.
        J Clin Monit Comput. 2019; 33: 249-257
        • Liu F
        • Lv J
        • Zhang W
        • Liu Z
        • Dong L
        • Wang Y.
        Randomized controlled trial of regional tissue oxygenation following goal-directed fluid therapy during laparoscopic colorectal surgery.
        Int J Clin Exp Pathol. 2019; 12: 4390-4399
        • Sujatha P
        • Nileshwar A
        • Krishna H
        • Prasad S
        • Prabhu M
        • Kamath S.
        Goal-directed vs traditional approach to intraoperative fluid therapy during open major bowel surgery: is there a difference?.
        Anesthesiol Res Pract. 2019; 2019: 1-11
        • Gómez-Izquierdo J
        • Trainito A
        • Mirzakandov D
        • et al.
        Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery.
        Anesthesiology. 2017; 127: 36-49
        • Reisinger K
        • Willigers H
        • Jansen J
        • et al.
        Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial.
        Colorectal Dis. 2017; 19: 1081-1091
        • Lin Q
        • Zhou H
        • Li D
        • Ye J
        • Hong J
        • Hu Y.
        Effect of perioperative goal-directed fluid therapy on clinical outcome in elective colorectal resection.
        Zhonghua Wei Chang Wai Ke Za Zhi. 2015; 18: 671-675
        • McKenny M
        • O'Malley C
        • Mehigan B
        • McCormick P
        • Dowd N.
        Introduction of oesophageal Doppler-guided fluid management in a laparoscopic colorectal surgery enhanced recovery programme: an audit of effect on patient outcome.
        Ir Med J. 2014; 107: 135-138
        • Phan T
        • An V
        • D'Souza B
        • Rattray M
        • Johnston M
        • Cowie B
        A randomised controlled trial of fluid restriction compared to oesophageal doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery after Surgery program.
        Anaesth Intensive Care. 2014; 42 (10.1177/0310057 × 1404200611): 752-760
        • Srinivasa S
        • Taylor M
        • Singh P
        • Yu T
        • Soop M
        • Hill A.
        Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy.
        Br J Surg. 2013; 100: 66-74
        • Zakhaleva J
        • Tam J
        • Denoya P
        • Bishawi M
        • Bergamaschi R.
        The impact of intravenous fluid administration on complication rates in bowel surgery within an enhanced recovery protocol: a randomized controlled trial.
        Colorectal Dis. 2013; 15: 892-899
        • Brandstrup B
        • Svendsen P
        • Rasmussen M
        • et al.
        Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?.
        Br J Anaesth. 2012; 109: 191-199
        • Challand C
        • Struthers R
        • Sneyd J
        • et al.
        Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery.
        Br J Anaesth. 2012; 108: 53-62
        • Jammer I
        • Ulvik A
        • Erichsen C
        • Lødemel O
        • Østgaard G.
        Does central venous oxygen saturation-directed fluid therapy affect postoperative morbidity after colorectal surgery?.
        Anesthesiology. 2010; 113: 1072-1080
        • Senagore A
        • Emery T
        • Luchtefeld M
        • Kim D
        • Dujovny N
        • Hoedema R.
        Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an Enhanced Recovery program.
        Dis Colon Rectum. 2009; 52: 1935-1940
        • Noblett S
        • Snowden C
        • Shenton B
        • Horgan A.
        Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection.
        Br J Surg. 2006; 93: 1069-1076
        • Wakeling H
        • McFall M
        • Jenkins C
        • et al.
        Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery.
        Br J Anaesth. 2005; 95: 634-642
        • Conway D
        • Mayall R
        • Abdul-Latif M
        • Gilligan S
        • Tackaberry C.
        Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery.
        Anaesthesia. 2002; 57: 845-849
      2. Higgins JPT, Thomas J, Chandler J, eds, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane. 2021. Available from Accessed May 1, 2022.

        • Zhu Q
        • Li X
        • Tan F
        • et al.
        Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery.
        BMC Gastroenterol. 2018; 18 (Published 2018 Oct 19): 152
        • Lewis S
        • Pritchard M
        • Evans D
        • et al.
        Colloids versus crystalloids for fluid resuscitation in critically ill people.
        Cochrane Database Syst Rev. 2018;
        • Perel P
        • Roberts I
        • Ker K.
        Colloids versus crystalloids for fluid resuscitation in critically ill patients.
        Cochrane Database Syst Rev. 2013;
        • Brunkhorst FM
        • Engel C
        • Bloos F
        • et al.
        Intensive insulin therapy and penta-starch resuscitation in severe sepsis.
        N Engl J Med. 2008; 358: 125-139
        • Myburgh JA
        • Finfer S
        • Bellomo R
        • et al.
        Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
        N Engl J Med. 2012; 367: 1901-1911
        • Perner A
        • Haase N
        • Guttormsen AB
        • et al.
        Hydroxyethyl starch 130(0.42 versus Ringer's acetate in severe sepsis.
        N Engl J Med. 2012; 367: 124-134
        • McEvoy M
        • Wanderer J
        • Shi Y
        • et al.
        The effect of adding goal-directed hemodynamic management for elective patients in an established enhanced recovery program for colorectal surgery: results of quasi-experimental pragmatic trial.
        Perioper Med (Lond). 2020; 9: 1-10
        • Sankar A
        • Beattie W
        • Wijeysundera D.
        How can we identify the high-risk patient?.
        Curr Opin Crit Care. 2015; 21: 328-335
      3. ASA Physical Status Classification System. Published 2020. Accessed May 23, 2022.

        • Dakik H
        • Sbaity E
        • Msheik A
        • et al.
        AUB-HAS2 Cardiovascular risk index: performance in surgical subpopulations and comparison to the revised cardiac risk index.
        J Am Heart Assoc. 2020; 9