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.
Editor’s Perspective:
What We Already Know about This Topic:
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The role of guided fluid management remains unclear, with contradictory trial results.
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The noninvasive plethysmographic variability index is one method of guiding fluid administration.
What This Article Tells Us That Is New:
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The investigators randomized 447 moderate-risk major arthroplasty patients to plethysmographic-guided versus routine fluid management.
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Fitness for discharge and actual hospital durations were essentially identical in each group. Complications were rare and similar in each group.
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Plethysmographic-guided fluid management did not reduce the duration of hospitalization or complications in moderate-risk surgery patients.