Results: In total, 447 patients were randomized, and 438 were included in the analysis. The mean hospital length of stay ± SD was 6 ± 3 days for the plethysmographic variability index group and 6 ± 3 days for the control group (adjusted difference, 0.0 days; 95% CI, −0.6 to 0.5; P = 0.860); the theoretical postoperative hospital length of stay was 4 ± 2 days for the plethysmographic variability index group and 4 ± 1 days for the control group (P = 0.238). In the plethysmographic variability index and control groups, serious postoperative cardiac complications occurred in 3 of 217 (1%) and 2 of 224 (1%) patients (P = 0.681), acute postoperative renal failure occurred in 9 (4%) and 8 (4%) patients (P = 0.808), the troponin Ic concentration was more than 0.06 μg/l within 5 days postoperatively for 6 (3%) and 5 (2%) patients (P = 0.768), and the postoperative arterial lactate measurements were 1.44 ± 1.01 and 1.43 ± 0.95 mmol/l (P = 0.974), respectively.
Conclusions: Among intermediate-risk patients having orthopedic surgery with general anesthesia, fluid administration guided by the plethysmographic variability index did not shorten the duration of hospitalization or reduce complications.
What We Already Know about This Topic:
The role of guided fluid management remains unclear, with contradictory trial results.
The noninvasive plethysmographic variability index is one method of guiding fluid administration.
What This Article Tells Us That Is New:
The investigators randomized 447 moderate-risk major arthroplasty patients to plethysmographic-guided versus routine fluid management.
Fitness for discharge and actual hospital durations were essentially identical in each group. Complications were rare and similar in each group.
Plethysmographic-guided fluid management did not reduce the duration of hospitalization or complications in moderate-risk surgery patients.