Perioperative Goal Directed Versus Conventional Fluid Therapy in Head and Neck Free Flap Surgery: A systematic review and meta-analysis
Research article published in Sultan Qaboos University medical journal (2025)
Abstract
Head and neck free flap surgery is associated with considerable morbidity and mortality. Goal-directed fluid therapy (GDFT) has been increasingly adopted in perioperative care; however, its benefit over conventional fluid therapy (CFT) in this setting remains uncertain. This systematic review and meta-analysis assessed the effect of GDFT versus CFT on post-operative outcomes. A comprehensive search of PubMed, Web of Science, Cochrane Library, Dental/Oral Science, and Google Scholar identified randomised controlled trials published between 2010 and 2023. Three studies involving 262 patients (130 GDFT, 132 CFT) were included. Pooled analysis showed no significant difference in flap failure between groups, but CFT was associated with higher risk of flap at risk (risk ratio 4.44; 95% confidence interval [CI]: 1.35-14.57; P = 0.01), reoperation (risk ratio 2.62; 95% CI: 1.01-6.79; P = 0.05), and longer intensive care unit stay (mean difference 0.94 days; P < 0.001). GDFT may improve outcomes, but larger studies are needed to confirm these findings.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This systematic review and meta-analysis pooled three randomized controlled trials (262 patients) comparing goal-directed fluid therapy (GDFT) with conventional fluid therapy in head and neck free-flap surgery, finding no significant difference in outright flap failure but a higher risk of flap compromise (risk ratio 4.44, 95% CI 1.35-14.57), more reoperation, and longer ICU stay with conventional therapy, while cautioning that larger studies are needed. It is relevant to the hirudotherapy clinical picture because free-flap survival is the setting where medicinal leeches are applied for venous congestion, and perioperative physiology such as fluid balance shapes the perfusion and venous-outflow problems leeches are used to manage. However, the analysis pools only three small trials, addresses fluid strategy rather than any leech or anticoagulant intervention, and the authors describe the GDFT benefit as suggestive and unconfirmed, so it bears on the surrounding surgical context only and not on leech therapy directly.
Citation
Perioperative Goal Directed Versus Conventional Fluid Therapy in Head and Neck Free Flap Surgery: A systematic review and meta-analysis.
Shamim et al. · Sultan Qaboos University medical journal, 2025
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026