FTSurgery.com - When time does matter

1. Doppler Guided
Intraoperative Fluid
Management: Data Analysis
NHS Technology Adoption Centre, January 2011.
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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.
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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 Surgery
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4. Pre-operative Morbidity Risk Assessment
(POSSUM Score): All Patients
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5. Mean Intra-operative Fluids
Administered (ml): All Patients
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6. Length of Stay: All Patients
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7. Post-operative Length of Stay:
All Patients
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8. 23% Decrease in Central Venous
Catheter Insertion Rates
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9. 29% Decrease in Re-admission Rate
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10. 30% Decrease in Re-operation Rate
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11. Critical Care Admission
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12. Critical Care LOS: Level 1
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13. Critical Care LOS: Level 2
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14. Critical Care LOS: Level 3
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15. 12% Decrease in Operative Mortality
Rate
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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).
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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.
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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.
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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.
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