SSI Reduction the Focus of Lancet Review. Meta-Analysis Supports GDHT… with Oesophageal Doppler “Doing the Heavy Lifting”
Surgical Site Infection (SSI), a troublesome, expensive and dreaded postoperative complication, is the focus of a significant new review. A substantial meta-analysis1 investigates reduction of SSI by application of Goal-Directed Haemodynamic therapy (GDHT).
Surgical site infection is a well-recognised undesirable postoperative complication. Indeed NHS data estimates the cost of a single infection at over £10,000 per person. A deep-incisional SSI can cost a staggering £100,000 2.
On this basis alone a meta-analysis of much of the available data is most welcome. This new study of 75 Randomised Controlled Trials (RCTs) includes 13,010 patients and covers multiple monitoring technologies. It includes 14 that relate to Deltex Medical’s proprietary Oesophageal Doppler Monitoring(ODM).
So when we saw the newly-published Lancet Article our antennae perked up. Picking our way through the metadata, here is another paper that reinforces our long-maintained assertion about GDHT using ODM. Deltex’s uniquely strong evidence base is unequivocal. It confirms that using our gold-standard haemodynamic monitoring technology yields significant reductions in all the main categories of postoperative complication. As the paper states, this includes SSI.
So to the review, which includes all popular monitoring methods. Headline findings suggest:
- High-certainty of evidence that GDHT algorithm reduces the risk of SSI after surgery compared to conventional fluid therapy
- GDHT also helps reduce other postoperative complications without evidence of harm
- Does not support the prior notion that GDHT is not effective in low-risk populations
- Doesn’t restrict the effectiveness of GDHT to gastrointestinal or cardiothoracic cases
Looking at the data in more detail we also conclude that:
- Studies involving application of GDHT using Deltex Medical’s ODM, represent a significant portion of the reported benefit from the total data set
SSI Reduction: Why Employ GDHT?
The cost alone makes avoidance of SSI highly desirable. To this end it’s broadly accepted that optimising perfusion is a key component in so doing. This is difficult to achieve, the haemodynamic “sweet spot” being small. It’s made more difficult because both hypovolaemia and hypervolaemia are associated with postoperative complications. In other words, as is broadly accepted, it’s not just about giving more fluid.
Why ODM?
Employing a system that can guide fluid and drug interventions with unparalleled accuracy and in real time is most likely to deliver meaningful guidance of interventions.
Oesophageal Doppler Monitoring (ODM) is integral to Deltex Medical’s newest TrueVue monitoring platform. Underpinning the technology is the goal of optimising tissue perfusion. As stated in the Lancet paper this is “essential in perioperative management”. It’s also at the heart of Deltex’s Mission Zero programme which targets all complications of haemodynamic origin.
The ODM system uses Doppler to measure cardiac output parameters directly from the descending aorta. As such ODM is uniquely capable of delivering accurate, real-time haemodynamic data. This level of precision could explain why ODM appears to outperform the study per se in SSI reduction.
Digging Deeper
The new review included a total of 13,010 patients. Meta-analysis indicated that the incidence of SSI was reduced from 13.3% in the conventional fluid management group to 9.4% in the GDHT group (absolute risk reduction 3.9%).
24 RCTs support the use of ODM, of which 14 are included in the Lancet review. These include the much vaunted FEDORA trial which showed statistically significant reductions in SSI (superficial and deep) of over 75%. (Superficial infection reduction from 4.74% to 0.96% of patients. Deep infection reduction from 8.06% 1.91% of patients).
Deltex Medical Comments
Deltex Medical CEO Andy Mears offers his views.
“I think it’s fair to say that clinicians often use the output of studies to validate and reaffirm their existing practice. Whichever monitoring technology one is employing, this weighty analysis can be used to justify the decision to employ GDHT. Dig a little deeper though and it’s apparent that GDHT using Deltex Medical’s ODM technology is doing much of the heavy lifting here. In fact if one extracts ODM data from the total it’s clear that the beneficial impact of GDHT without ODM is far less.
“It’s also noteworthy that the authors reject calls for more RCTs to prove other benefits because of potential harms of not employing GDHT in control patients. That’s a ringing endorsement for GDHT. The implication is that not using GDHT should not be an option. Given the strength of data in support of ODM, I’d argue that applying GDHT using anything other than the proven technology leader should also not be an option!”
References
1 Systematic review and meta-analysis of goal-directed haemodynamic therapy algorithms during surgery for the prevention of surgical site infection, Jalalzadeh et al, The Lancet. https://doi.org/10.1016/j.eclinm.2024.102944
2 Getting It Right First Time. GIRFT SSI National Survey. 2019. https://gettingitrightfirsttime.co.uk/wp-content/uploads/2017/08/SSI-Report-GIRFT-APRIL19e-FINAL.pdf
