Table 2.
GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). ∗The majority of the trials were rated as having an intermediate risk of bias. †The 95% confidence interval includes both potential benefit and no effect. ‡Substantial heterogeneity (I2=78%), but few trials showing harm. ¶Wide 95% confidence interval including both potential benefit and harm. §Optimal information size not reached, see Supplementary Content S2. ||Confidence interval includes both benefit and harm. #Moderate inconsistency (I2=41%). CI, confidence interval; OR, odds ratio; MD, mean difference.
| Certainty assessment |
Number of patients (events/total (%) or n) |
Effect |
Certainty | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of trials | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other | Goal-directed therapy | Standard of care | Relative (95% CI) | Absolute (95% CI) | |
| Mortality | |||||||||||
| 39 | RCTs | Serious∗ | Not serious | Not serious | Serious† | None | 124/2723 (4.6%) | 134/2604 (5.1%) | OR 0.84 (0.64–1.09) | 8 fewer per 1000 (from 18 fewer to 4 more) | ⊕⊕◯ ◯ LOW |
| Hospital length of stay | |||||||||||
| 65 | RCTs | Serious∗ | Serious‡ | Not serious | Not serious | None | 3838 | 3723 | – | MD 0.7 days fewer (1.1 fewer to 0.4 fewer) | ⊕⊕◯ ◯ LOW |
| Pneumonia | |||||||||||
| 33 | RCTs | Serious∗ | Not serious | Not serious | Not serious | None | 124/2122 (5.8%) | 174/2103 (8.3%) | OR 0.69 (0.55–0.88) | 24 fewer per 1000 (from 35 fewer to 9 fewer) | ⊕⊕⊕◯ MODERATE |
| Pulmonary oedema | |||||||||||
| 2 | RCTs | Serious∗ | Not serious | Not serious | Very serious¶ | None | 2/430 (0.5%) | 2/428 (0.5%) | OR 1.00 (0.14–7.08) | 0 fewer per 1000 (from 4 fewer to 27 more) | ⊕◯ ◯ ◯ VERY LOW |
| Pulmonary embolism | |||||||||||
| 9 | RCTs | Serious∗ | Not serious | Not serious | Very serious¶ | None | 13/834 (1.6%) | 16/844 (1.9%) | OR 0.82 (0.39–1.71) | 3 fewer per 1000 (from 11 fewer to 13 more) | ⊕◯ ◯ ◯ VERY LOW |
| Acute respiratory distress syndrome | |||||||||||
| 4 | RCTs | Serious∗ | Not serious | Not serious | Serious§ | None | 5/625 (0.8%) | 18/625 (2.9%) | OR 0.32 (0.14–0.74) | 19 fewer per 1000 (from 25 fewer to 7 fewer) | ⊕⊕◯ ◯ LOW |
| Myocardial infarction | |||||||||||
| 13 | RCTs | Serious∗ | Not serious | Not serious | Serious|| | None | 29/1405 (2.1%) | 32/1413 (2.3%) | OR 0.91 (0.55–1.52) | 2 fewer per 1000 (from 10 fewer to 11 more) | ⊕⊕◯ ◯ LOW |
| Arrhythmia | |||||||||||
| 3 | RCTs | Serious∗ | Not serious | Not serious | Serious|| | None | 6/259 (2.3%) | 13/261 (5.0%) | OR 0.46 (0.18–1.16) | 26 fewer per 1000 (from 40 fewer to 8 more) | ⊕⊕◯ ◯ LOW |
| Acute kidney injury | |||||||||||
| 18 | RCTs | Serious∗ | Serious# | Not serious | Serious† | None | 147/1760 (8.4) | 166/1663 (10.0) | OR 0.83 (0.65–1.06) | 16 fewer per 1000 (from 33 fewer to 5 more) | ⊕◯ ◯ ◯ VERY LOW |
| Surgical site infection | |||||||||||
| 39 | RCTs | Serious∗ | Not serious | Not serious | Not serious | None | 183/2346 (7.8%) | 294/2301 (12.8%) | OR 0.54 (0.45–0.66) | 54 fewer per 1000 (from 66 fewer to 40 fewer) | ⊕⊕⊕◯ MODERATE |
| Paralytic ileus | |||||||||||
| 15 | RCTs | Serious∗ | Not serious | Not serious | Serious† | None | 108/1232 (8.8%) | 127/1221 (10.4%) | OR 0.83 (0.63–1.10) | 16 fewer per 1000 (from 36 fewer to 9 more) | ⊕⊕◯ ◯ LOW |
| Anastomotic leakage | |||||||||||
| 21 | RCTs | Serious∗ | Not serious | Not serious | Not serious | None | 55/1664 (3.3%) | 81/1568 (5.2%) | OR 0.61 (0.43–0.87) | 19 fewer per 1000 (from 29 fewer to 6 fewer) | ⊕⊕⊕◯ MODERATE |
| Delirium | |||||||||||
| 16 | RCTs | Serious∗ | Not serious | Not serious | Serious† | None | 74/1502 (4.9%) | 98/1492 (6.6%) | OR 0.72 (0.52–0.99) | 18 fewer per 1000 (from 30 fewer to 1 fewer) | ⊕⊕◯ ◯ LOW |