Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study
Purpose Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients. Methods Al...
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| Veröffentlicht in: | Intensive care medicine 2010-08, Vol.36 (8), p.1327-1332 |
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| container_title | Intensive care medicine |
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| creator | Rhodes, Andrew Cecconi, Maurizio Hamilton, Mark Poloniecki, Jan Woods, Justin Boyd, Owen Bennett, David Grounds, R. Michael |
| description | Purpose
Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.
Methods
All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.
Results
Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (
p
= 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days,
p
= 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02–1.07),
p
|
| doi_str_mv | 10.1007/s00134-010-1869-6 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_754868573</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724337684</galeid><sourcerecordid>A724337684</sourcerecordid><originalsourceid>FETCH-LOGICAL-c526t-dfe6bdd190a075a7609517e2aa552f9135c7d3fd3a49b392f58202f5ce6431d33</originalsourceid><addsrcrecordid>eNqNkU1rFDEYgIModlv9AV4kKMVTNN-Z6a0UrUKhFz2Hd_Oxmzo7MyYzyP57M8xqQRC8JIQ87-eD0CtG3zNKzYdCKROSUEYJa3RL9BO0YVJwwrhonqINFZITqSU_Q-elPFTaaMWeozNOhdFSsA26vx2gIz7l4Kbg8bQPGcYjTj3ep92e5FS-4zLnXXLQ4RGmFPqpXGHATJFjgIzj0HXDTzKPuEyzP75AzyJ0Jbw83Rfo26ePX28-k7v72y8313fEKa4n4mPQW-9ZS4EaBUbTVjETOIBSPLZMKGe8iF6AbLei5VE1nNbThaVtL8QFerfmHfPwYw5lsodUXOg66MMwF2uUbHSjzH-QQmgldLOQb_4iH4Y593UMW_trVd2aqtDbFdpBF2zq4zBlcEtKe224FHWxjawUWymXh1JyiHbM6QD5aBm1izu7urN0eVd3VteY16fy8_YQ_J-I37IqcHkCoFQdMUPvUnnkBBUNZ23l-MqV-tXvQn6c49_VfwFcqa16</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>609952035</pqid></control><display><type>article</type><title>Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Rhodes, Andrew ; Cecconi, Maurizio ; Hamilton, Mark ; Poloniecki, Jan ; Woods, Justin ; Boyd, Owen ; Bennett, David ; Grounds, R. Michael</creator><creatorcontrib>Rhodes, Andrew ; Cecconi, Maurizio ; Hamilton, Mark ; Poloniecki, Jan ; Woods, Justin ; Boyd, Owen ; Bennett, David ; Grounds, R. Michael</creatorcontrib><description>Purpose
Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.
Methods
All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.
Results
Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (
p
= 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days,
p
= 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02–1.07),
p
< 0.0001], randomization to the goal-directed group of the study [HR 0.61 (0.4–0.92),
p
= 0.02], and avoidance of a significant postoperative cardiac complication [HR 3.78 (2.16–6.6),
p
= 0.007].
Conclusions
Long-term survival after major surgery is related to a number of factors, including patient age and avoidance of perioperative complications. Short-term goal-directed therapy in the perioperative period may improve long-term outcomes, in part due to its ability to reduce the number of perioperative complications.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-010-1869-6</identifier><identifier>PMID: 20376431</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthesiology ; Biological and medical sciences ; Care and treatment ; Clinical Protocols ; Clinical trials ; Critical Care Medicine ; Diseases of the respiratory system ; Emergency Medicine ; Follow-Up Studies ; Guideline Adherence ; Hemodynamics ; Hospital patients ; Hospitals ; Humans ; Hypotheses ; Intensive ; Intensive care ; Intensive care medicine ; Life expectancy ; Medical research ; Medical sciences ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Mortality ; Original ; Pain Medicine ; Patient-Centered Care ; Patients ; Pediatrics ; Perioperative Care - standards ; Pneumology/Respiratory System ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Randomized Controlled Trials as Topic ; Risk Assessment ; Surgery ; Surgical Procedures, Operative - rehabilitation ; Survival Analysis</subject><ispartof>Intensive care medicine, 2010-08, Vol.36 (8), p.1327-1332</ispartof><rights>Copyright jointly held by Springer and ESICM 2010</rights><rights>2015 INIST-CNRS</rights><rights>COPYRIGHT 2010 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-dfe6bdd190a075a7609517e2aa552f9135c7d3fd3a49b392f58202f5ce6431d33</citedby><cites>FETCH-LOGICAL-c526t-dfe6bdd190a075a7609517e2aa552f9135c7d3fd3a49b392f58202f5ce6431d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-010-1869-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-010-1869-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23038219$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20376431$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rhodes, Andrew</creatorcontrib><creatorcontrib>Cecconi, Maurizio</creatorcontrib><creatorcontrib>Hamilton, Mark</creatorcontrib><creatorcontrib>Poloniecki, Jan</creatorcontrib><creatorcontrib>Woods, Justin</creatorcontrib><creatorcontrib>Boyd, Owen</creatorcontrib><creatorcontrib>Bennett, David</creatorcontrib><creatorcontrib>Grounds, R. Michael</creatorcontrib><title>Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.
Methods
All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.
Results
Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (
p
= 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days,
p
= 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02–1.07),
p
< 0.0001], randomization to the goal-directed group of the study [HR 0.61 (0.4–0.92),
p
= 0.02], and avoidance of a significant postoperative cardiac complication [HR 3.78 (2.16–6.6),
p
= 0.007].
Conclusions
Long-term survival after major surgery is related to a number of factors, including patient age and avoidance of perioperative complications. Short-term goal-directed therapy in the perioperative period may improve long-term outcomes, in part due to its ability to reduce the number of perioperative complications.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthesiology</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>Clinical Protocols</subject><subject>Clinical trials</subject><subject>Critical Care Medicine</subject><subject>Diseases of the respiratory system</subject><subject>Emergency Medicine</subject><subject>Follow-Up Studies</subject><subject>Guideline Adherence</subject><subject>Hemodynamics</subject><subject>Hospital patients</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Life expectancy</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Mortality</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Patient-Centered Care</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Perioperative Care - standards</subject><subject>Pneumology/Respiratory System</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Assessment</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - rehabilitation</subject><subject>Survival Analysis</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1rFDEYgIModlv9AV4kKMVTNN-Z6a0UrUKhFz2Hd_Oxmzo7MyYzyP57M8xqQRC8JIQ87-eD0CtG3zNKzYdCKROSUEYJa3RL9BO0YVJwwrhonqINFZITqSU_Q-elPFTaaMWeozNOhdFSsA26vx2gIz7l4Kbg8bQPGcYjTj3ep92e5FS-4zLnXXLQ4RGmFPqpXGHATJFjgIzj0HXDTzKPuEyzP75AzyJ0Jbw83Rfo26ePX28-k7v72y8313fEKa4n4mPQW-9ZS4EaBUbTVjETOIBSPLZMKGe8iF6AbLei5VE1nNbThaVtL8QFerfmHfPwYw5lsodUXOg66MMwF2uUbHSjzH-QQmgldLOQb_4iH4Y593UMW_trVd2aqtDbFdpBF2zq4zBlcEtKe224FHWxjawUWymXh1JyiHbM6QD5aBm1izu7urN0eVd3VteY16fy8_YQ_J-I37IqcHkCoFQdMUPvUnnkBBUNZ23l-MqV-tXvQn6c49_VfwFcqa16</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Rhodes, Andrew</creator><creator>Cecconi, Maurizio</creator><creator>Hamilton, Mark</creator><creator>Poloniecki, Jan</creator><creator>Woods, Justin</creator><creator>Boyd, Owen</creator><creator>Bennett, David</creator><creator>Grounds, R. Michael</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20100801</creationdate><title>Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study</title><author>Rhodes, Andrew ; Cecconi, Maurizio ; Hamilton, Mark ; Poloniecki, Jan ; Woods, Justin ; Boyd, Owen ; Bennett, David ; Grounds, R. Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-dfe6bdd190a075a7609517e2aa552f9135c7d3fd3a49b392f58202f5ce6431d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthesiology</topic><topic>Biological and medical sciences</topic><topic>Care and treatment</topic><topic>Clinical Protocols</topic><topic>Clinical trials</topic><topic>Critical Care Medicine</topic><topic>Diseases of the respiratory system</topic><topic>Emergency Medicine</topic><topic>Follow-Up Studies</topic><topic>Guideline Adherence</topic><topic>Hemodynamics</topic><topic>Hospital patients</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypotheses</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Life expectancy</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Mortality</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Patient-Centered Care</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Perioperative Care - standards</topic><topic>Pneumology/Respiratory System</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Assessment</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - rehabilitation</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rhodes, Andrew</creatorcontrib><creatorcontrib>Cecconi, Maurizio</creatorcontrib><creatorcontrib>Hamilton, Mark</creatorcontrib><creatorcontrib>Poloniecki, Jan</creatorcontrib><creatorcontrib>Woods, Justin</creatorcontrib><creatorcontrib>Boyd, Owen</creatorcontrib><creatorcontrib>Bennett, David</creatorcontrib><creatorcontrib>Grounds, R. Michael</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rhodes, Andrew</au><au>Cecconi, Maurizio</au><au>Hamilton, Mark</au><au>Poloniecki, Jan</au><au>Woods, Justin</au><au>Boyd, Owen</au><au>Bennett, David</au><au>Grounds, R. Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>36</volume><issue>8</issue><spage>1327</spage><epage>1332</epage><pages>1327-1332</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>Purpose
Goal-directed therapy in the perioperative setting has been shown to be associated with short-term improvements in outcome. This study assesses the longer-term survival of patients from a previous randomized controlled trial of goal-directed therapy in high-risk surgical patients.
Methods
All patients from a previous randomized controlled study were followed up for 15 years following randomization to ascertain their length of survival following surgery. Factors that may be associated with increased survival were evaluated to determine what influenced long-term outcomes.
Results
Data from 106 of the original 107 patients (99%) were available for analysis. At 15 years, 11 (20.7%) of the goal-directed therapy patients versus 4 (7.5%) of the control group were alive (
p
= 0.09). Median survival for the goal-directed group was increased by 1,107 days (1,781 vs. 674 days,
p
= 0.005). Long-term survival was associated with three independent factors: age [hazard ratio (HR) 1.04 (1.02–1.07),
p
< 0.0001], randomization to the goal-directed group of the study [HR 0.61 (0.4–0.92),
p
= 0.02], and avoidance of a significant postoperative cardiac complication [HR 3.78 (2.16–6.6),
p
= 0.007].
Conclusions
Long-term survival after major surgery is related to a number of factors, including patient age and avoidance of perioperative complications. Short-term goal-directed therapy in the perioperative period may improve long-term outcomes, in part due to its ability to reduce the number of perioperative complications.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>20376431</pmid><doi>10.1007/s00134-010-1869-6</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2010-08, Vol.36 (8), p.1327-1332 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_754868573 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthesiology Biological and medical sciences Care and treatment Clinical Protocols Clinical trials Critical Care Medicine Diseases of the respiratory system Emergency Medicine Follow-Up Studies Guideline Adherence Hemodynamics Hospital patients Hospitals Humans Hypotheses Intensive Intensive care Intensive care medicine Life expectancy Medical research Medical sciences Medicine Medicine & Public Health Medicine, Experimental Mortality Original Pain Medicine Patient-Centered Care Patients Pediatrics Perioperative Care - standards Pneumology/Respiratory System Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Randomized Controlled Trials as Topic Risk Assessment Surgery Surgical Procedures, Operative - rehabilitation Survival Analysis |
| title | Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study |
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