Authors: Hovgaard H et al.
Anesthesiology 144(4):823–836, April 2026
Summary:
This randomized controlled trial examined whether extending goal-directed fluid therapy (GDFT) beyond the operating room and individualizing blood pressure targets improves outcomes after esophagectomy. Patients were randomized to either standard care or an intervention strategy that optimized cardiac output and used each patient’s baseline nighttime mean arterial pressure as a target, continuing treatment through the first postoperative morning.
While the intervention successfully changed management—patients received more fluids, more norepinephrine, and maintained slightly higher blood pressures—these physiologic improvements did not translate into better outcomes. The primary endpoint, postoperative morbidity measured by the Comprehensive Complication Index at 30 days, was essentially identical between groups.
This suggests that even with more personalized and extended hemodynamic optimization, postoperative complications were not reduced. The findings challenge the assumption that tighter control of fluid status and blood pressure, even when individualized, will necessarily improve outcomes in high-risk surgery.
Ultimately, the study highlights the complexity of perioperative care and suggests that factors beyond hemodynamic targets play a significant role in determining outcomes after major surgery.
Key Points:
- Extended, individualized goal-directed therapy changed physiology but not outcomes
- No reduction in postoperative complications despite higher fluids and vasopressor use
- Personalized MAP targets did not improve results
- More aggressive hemodynamic management does not guarantee better outcomes
What You Should Know:
We adjusted everything—fluids, pressors, blood pressure—and nothing changed. That’s the takeaway. This reinforces that perioperative outcomes aren’t just about hemodynamics, and chasing numbers alone isn’t enough.
We would like to thank Anesthesiology for allowing us to summarize and share this article.