This document analyzes data from a study comparing Doppler guided intraoperative fluid management (intervention) to standard care (control) in surgical patients. Key findings include: a 67% decrease in operative mortality rate, reductions of 3 days in length of stay and 4 days in post-operative length of stay, and decreases of 23% in central venous catheter insertion rates, 33% in re-admission rates, and 25% in re-operation rates with the intervention. Length of stay in the highest level of critical care was reduced by 11 days.

1. 1
DOPPLER GUIDED INTRAOPERATIVE
FLUID MANAGEMENT: DATA
ANALYSIS
NHS Technology Adoption Centre, January 2010.

2. Intervention vs. Comparator
2
Intervention (n = 626)
London: 1st April 2008 – 30th April 2009;
Manchester: 1st January 2009 – 30th November 2009;
Derby: 19th September 2008 – 30th November 2009.
Control (n = 621)
London: 1st March 2007 – 31st March 2008;
Manchester: 1st January 2008 – 30th December 2008;
Derby: 1st March 2007 – 18th September 2008.

3. Surgical Procedures
3
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.

4. Pre-operative Morbidity Risk
4
Assessment POSSUM: All Patients

5. 67% Decrease in Operative Mortality Rate
5

6. Intra-operative fluids administered: All
6
Patients

7. Length of Stay: All Patients
7

8. Post-operative Length of Stay: All
8
Patients

9. 23% Decrease in Central Venous
9
Catheter Insertion Rates

10. 33% Decrease in Re-admission Rate
10

11. 25% Decrease in Re-operation Rate
11

12. Critical Care Admission
12

13. Critical Care Length of Stay
13
Level 1:
Mean LOS – Intervention 3.11 Days, Control 2.95 Days.
Median LOS – Intervention 3 Days, Control 3 Days.
Level 2:
Mean LOS – Intervention 4.58 Days, Control 4.73 Days.
Median LOS – Intervention 3 Days, Control 3 Days.
Level 3:
Mean LOS – Intervention 8.40 Days, Control 19.31 Days.
Median LOS – Intervention 6.5 Days, Control 11 Days.

14. Critical Care LOS: Level 1
14

15. Critical Care LOS: Level 2
15

16. Critical Care LOS: Level 3
16

17. Statistical significance
17
POSSUM score - Independent t-test
Two-sided P = 0.020; Significant differences in
POSSUM scores between the two groups.
LOS and Post-op LOS - Independent t-test
Two-sided P = 0.001 and P = 0.000 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).

18. Statistical significance
18
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 = 0.286 and P = 0.212 respectively; No
significant differences in re-admission and re-operative
rates between the two groups.

19. Statistical significance
19
Mortality rate – Independent t-test
Two-sided P = 0.001; Significant differences in
mortality rates between the two groups.
LOS in critical care levels 1,2 & 3 – Mann-Whitney
test
P = 0.265, P = 0.775 and P = 0.277 respectively; No
significance differences observed in the length of stay
for critical care levels 1,2 & 3 between the two groups.

20. Results Summary
20
67% Decrease in Mortality
Three Day Reduction in Length of Stay
Four Day Reduction in Post-op LOS
23% Decrease in CVC Insertion Rate
33% Decrease in Re-admission Rate
25% Decrease in Re-operation Rate
Eleven Day Reduction in LOS within Critical Care Level Three