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Doppler guided intraoperative fluid management evidence base
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Doppler guided intraoperative fluid management evidence base

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FTSurgery.com - When time does matter

FTSurgery.com - When time does matter

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  • 1. Doppler Guided Intraoperative Fluid Management: Data AnalysisNHS Technology Adoption Centre, January 2011.1
  • 2. Intervention vs. Comparator Intervention (n = 649) London: 1st April 2008 – 30th April 2009; Manchester: 1st January 2009 – 30th November 2009; Derby: 19th September 2008 – 30th November 2009. Control (n = 658) London: 1st March 2007 – 31st March 2008; Manchester: 1st January 2008 – 30th December 2008; Derby: 1st March 2007 – 18th September 2008.2
  • 3. Surgical Procedures Orthopaedics: Joint Replacement. Lower GI: Hartmann’s, Colectomy, Hemicolectomy. Upper GI: Whipples, Gastrostomy. Colorectal: Laparotomy, Bowel and Anterior Resection. Renal and Pancreas Transplants. Urological Cancer: Cystectomy and Nephrectomy. Vascular Surgery : Aortic or Abdominal Vascular Surgery3
  • 4. Pre-operative Morbidity Risk Assessment (POSSUM Score): All Patients4
  • 5. Mean Intra-operative Fluids Administered (ml): All Patients5
  • 6. Length of Stay: All Patients6
  • 7. Post-operative Length of Stay: All Patients7
  • 8. 23% Decrease in Central Venous Catheter Insertion Rates8
  • 9. 29% Decrease in Re-admission Rate9
  • 10. 30% Decrease in Re-operation Rate10
  • 11. Critical Care Admission11
  • 12. Critical Care LOS: Level 112
  • 13. Critical Care LOS: Level 213
  • 14. Critical Care LOS: Level 314
  • 15. 12% Decrease in Operative Mortality Rate15
  • 16. Statistical significance POSSUM score - Independent t-test Two-sided P = 0.460; No significant differences in POSSUM scores between the two groups. LOS and Post-op LOS - Independent t-test Two-sided P = 0.002 and P = 0.001 respectively; Significant differences in LOS and post-op LOS between the two groups. Note: If the p-value is <=0.05 the factor of interest is statistically different between the intervention and control (i.e. significant).16
  • 17. Statistical significance CVC insertion - Independent t-test Two-sided P = 0.000; Significant differences in CVC insertion rate between the two groups. Re-admission and Re-operative rates – Independent t-test Two sided P = 0.165 and P = 0.078 respectively; No significant differences in re-admission and re-operative rates between the two groups.17
  • 18. Statistical significance Mortality rate – Independent t-test Two-sided P = 0.851; No significant differences in mortality rates between the two groups. LOS in critical care levels 1,2 & 3 – Independent t-test (level 1) & Mann-Whitney test (level 2, 3) P = 0.530, P = 0.321 and P = 0.347 respectively; No significant differences observed in the length of stay for critical care levels 1,2 & 3 between the two groups.18
  • 19. Results Summary Three and half day reduction in length of stay (LOS); Three and a half day reduction in Post-op LOS; 23% decrease in CVC insertion rate; 29% decrease in re-admission rate; 30% decrease in re-operation rate; 12% decrease in mortality; Five day reduction in LOS within critical care level three.19