Optimise: Optimisation of peri-operative cardiovascular management to improve surgical outcome
Background
Previous research has shown that treatment designed to improve the amount of oxygen delivered to the body’s tissues may reduce the number of complications patients develop after major surgery. This treatment involves using intravenous fluids and a drug called dopexamine which is known to improve heart function.
The aim of the Optimise study was to find out whether using a treatment plan to deliver intravenous fluid and dopexamine during and soon after surgery is better than usual care
Design
The study took place in 17 NHS hospitals throughout the UK. A total of 734 patients aged 50 years or older undergoing major gastrointestinal surgery joined the trial. Half were randomly assigned to the treatment plan to deliver intravenous fluid and dopexamine during and soon after surgery. The other half were assigned to usual care (control group). The study started in June 2010 and finished recruitment in November 2012. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.
Results
After 30 days, 37% of patients in the treatment plan had either had a major complication or died, compared with 43% in the usual-care group. Although fewer patients had either a major complication or had died in the treatment plan group, the difference was small and may have occurred by chance. When combined with data in the updated meta-analysis this indicated that the treatment plan was associated with a reduction in complication rates.
Conclusion
Although we could not prove that use of the treatment plan to deliver intravenous fluid and dopexamine during and soon after surgery reduced the outcome of major complications or death, when combined with other similar studies it indicated that there was a reduction in complication rates.
Who led the study?
Prof Rupert Pearse, The Royal London Hospital
This study is funded by the National Institute for Health and Care Research (NIHR) – Coordinating Centre for Research Capacity Development (Project: NIHRCS/01/2008/017). This study was sponsored by Queen Mary, University of London
Publications
Sadique Z, Harrison DA, Grieve R, Rowan KM, Pearse RM. Cost-effectiveness of a cardiac output-guided haemodynamic therapy algorithm in high-risk patients undergoing major gastrointestinal surgery. Perioper Med (Lond) 2015; 4:13. http://dx.doi.org/10.1186/s13741-015-0024-x
Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA 2014; 311(21):2181-90. http://dx.doi.org/10.1001/jama.2014.5305
Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane Systematic Review. Br J Anaesth 2013; 111(4):535-48. http://dx.doi.org/10.1093/bja/aet155
Grocott MP, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev 2012; 11:CD004082. http://dx.doi.org/10.1002/14651858.CD004082.pub5
