The Effect of Goal-Directed Fluid Therapy on Intraoperative Transfusion in Spine Surgery: A Double-Blind Randomized Clinical Trial

Abstract

Background: Fluid therapy in spine surgery presents significant challenges due to substantial intraoperative bleeding, which can lead to decreased cardiac output. Objectives: The present study investigated whether a specific approach to administering fluids during surgery (targeted fluid therapy) could reduce the need for blood transfusions in spinal surgeries. Methods: This study was a double-blind clinical trial involving 60 patients aged 18 - 70 years who were candidates for elective intervertebral disc herniation surgery with a duration of less than 4 hours and an ASA classification of I or II. The study was conducted at Golestan Hospital, Ahvaz, Iran, from 2020 to 2022. Patients were randomized using a computer-generated randomization chart and identical opaque envelopes for concealment to receive either goal-directed fluid therapy (GDFT) or the conventional method as the control group. Patients with cardiac, pulmonary, kidney, or liver diseases, those taking oral anticoagulants, and any who were dissatisfied with participation were excluded. In the targeted group, fluid therapy was administered according to the GDFT protocol. In the control group, fluid therapy was performed using crystalloid fluids based on the standard formula: 1 - 2 - 4 mg/kg for NPO hours, along with an additional 10 cc/kg during the fluid administration period. Both patients and the surgeon were blinded to the type of fluid therapy, and all surgeries were performed by the same surgeon. Results: The study found that the amount of transfusion in the control group (370.15 ± 115.20) was higher than in the GDFT group (350.15 ± 110.15), but this difference was not statistically significant (P = 0.796). The average amount of bleeding was 361.67 ± 112.712 in the GDFT group and 386.67 ± 143.198 in the control group (P = 0.587). The volume of fluid input was significantly lower in the GDFT group compared to the control group (3583.33 ± 373.320 versus 4090.00 ± 628.271, P = 0.01). Conclusions: The GDFT did not significantly reduce transfusions in this population (P = 0.796), possibly due to study limitations. While it did reduce fluid volumes (P = 0.01), broader clinical benefits were not observed. Further research should evaluate GDFT in high-risk patients undergoing longer procedures.