Economic Burden of Postoperative Complications: Would Perioperative Goal Directed Therapy Help?


Program Description / Statement of Need:

Fluid administration is a cornerstone of perioperative care, with the ultimate goal being the maintenance of intravascular volume in a fashion that incurs the fewest complications. There is a wide spectrum of risk inherent in different perioperative fluid managements strategies. On one hand, failing provoke a shunting of what intravascular volume remains away from the so-called “nonvital” organs to organs such as the brain and the heart. Clinical manifestations of under-resuscitation include postoperative complications ranging from the inconvenient and unpleasant (e.g., dizziness and post-operative nausea and vomiting) to those that acutely complicate the course of care such as: acute kidney injury and impaired wound healing as a result of inadequate blood flow to surgical anastamoses. On the other hand, over-resuscitation engenders risks such as pulmonary edema and its ensuing complications like impairment of pulmonary function, post-operative coagulopathy, abdominal compartment syndrome, gastrointestinal edema, impaired tolerance to enteral feeding, and increased bacterial translocation from the gut, which may in turn increase the risk of systemic inflammatory response syndromes and multiorgan system dysfunction.


Conventionally, perioperative fluid management methodology has entailed a “recipe book” or one-size-fits all approach that emphasizes settling on a continuous rate of fluid administration and replacing additional losses only as they occur. That strategy has come under fire for its failure to take a number of variables into account, including: preoperative fluid status, challenges relating to accurate measurement of intraoperative fluid loss, and perioperative variations in cardiac function and vascular tone. Thus, the medical literature is rife with studies, not to mention opinion, debating the merits of liberal versus restrictive fluid management strategies in populations ranging from orthopedic to intraabdominal surgeries. In the end, reviews of the literature and recent studies have begun to argue in favor of an adaptable approach that emphasizes specific patient population and surgical types in addition to moment-to-moment intraoperative fluid and pressure estimates and measurements aiding conventional decision drivers intraoperatively.


Dr. Manecke discusses the economic burden of complications of surgery and how perioperative goal-directed therapy may provide some opportunities to optimize practice in and around the clinical experience of the operating room setting.




  • Surgical complications, measured in quality and numbers
  • The dangers represented by sodium and hyper- and hypovolemia
  • Enhanced recovery after surgery (ERAS) in a snapshot
  • Perioperative goal-directed therapy (PDGT) in a snapshot
  • PDGT: does it work? What does the literature have to say?
  • Components of the ideal PDGT algorithm
  • A sample PDGT algorithm


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

Program Objectives:

By the end of the session the participant will be able to:

    • Describe the gravity of risk, both in numbers and the range of different possibilities that a surgical complication poses to a patientís short- and long-term well-being
    • Describe in concrete terms the risks posed by fluids commonly administered in the operating room
    • List some of the benefits in terms of concrete clinical outcomes of perioperative goal-directed therapy (PGDT)
    • Apply a PGDT algorithm to a patient


    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.


    Credit Designation: ScientiaCME designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Release Date: September 12, 2015
    Expiration Date: November 12, 2017

    Faculty: Gerald Manecke Jr. MD

    Faculty Disclosure and Resolution of COI:

     As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through  content review ScientiaCME.


    Faculty Disclosure:

    Dr.  Gerald Manecke Jr., MD discloses that he is a consultant / speaker for Edwards Lifesciences and Deltex.


    Disclosures of Educational Planner: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commercial supporter of this program: Edwards Lifesciences .


    Commercial Support Disclosure: This program is supported by an educational grant from Edwards Lifesciences 


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This program is supported by Educational Grants from Edwards Lifesciences.