Abstract
Introduction: patients with critical comorbidities undergoing major abdominal surgery face elevated risks of complications due to reduced physiological reserve. Hemodynamic and metabolic optimization strategies, including goal-directed fluid therapy and glycemic or nutritional protocols, may improve perioperative outcomes. This systematic review evaluates the effectiveness of such interventions in high-risk patients.
Methodology: a systematic search was performed in PubMed, Google Scholar and Cochrane Library up to May 2025. Eligible studies included randomized controlled trials and cohort observational studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and the Newcastle–Ottawa Scale for observational studies. Two reviewers independently screened and extracted data.
Results: seventeen studies evaluated hemodynamic and metabolic optimization in high-risk abdominal surgery. Hemodynamic strategies—such as goal-directed fluid therapy guided by cardiac index or stroke volume variation—were associated with reductions in 30-day mortality (15.5% vs. 21.8%, p=0.005), complications, ICU admissions, and length of stay in several trials. However, outcomes were inconsistent across studies, with some showing no significant benefits. Metabolic optimization, including glycemic control and individualized nutrition, improved nitrogen balance, body composition, glycemic targets, and reduced liver dysfunction. Malnutrition was linked to increased complications and prolonged hospital stay. While many interventions showed promising results, variability in study designs and outcomes limits definitive conclusions.
Conclusion: hemodynamic and metabolic optimization may improve outcomes in high-risk abdominal surgery, though effects vary. Multimodal strategies targeting fluid balance, glycemic control, and nutrition appear beneficial.