***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: The use of adequate fluid therapy during  cytoreductive surgery ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC )  remains controversial . The aim of the study was to assess whether the use of fluid therapy protocol combined with goal -directed therapy ( GDT ) is associated with a significant change in morbidity , length of hospital stay , and mortality compared to st and ard fluid therapy . Patients American Society of Anesthesiologists ( ASA ) II – III undergoing CRS and HIPEC were r and omized into two groups . The GDT group ( N = 38 ) received fluid therapy according to a protocol guided by monitored hemodynamic parameters . The control group ( N = 42 ) received st and ard fluid therapy . We evaluated incidence of major complications , total length of hospital stay , total amount of fluids administered , and mortality rate . The incidence of major abdominal complications was 10.5 % in GDT group and 38.1 % in the control group ( P = 0.005 ) . The median duration of hospitalization was 19 days in GDT group and 29 days in the control group ( P < 0.0001 ) . The mortality rate was zero in GDT group vs 9.5 % in the control group ( P = 0.12 ) . GDT group received a significantly ( P < 0.0001 ) lower amount of fluid ( 5812 ± 1244 ml ) than the control group ( 8269 ± 1452 ml ) , with a significantly ( P < 0.0001 ) lower volume of crystalloids ( 3884 ± 1003 vs 68,528 ± 1413 ml ) . In CRS and HIPEC , the use of a GDT improves outcome in terms of incidence of major abdominal and systemic postoperative complications and length of hospital stay , compared to st and ard fluid therapy protocol Introduction Several studies have shown that goal -directed hemodynamic and fluid optimization may result in improved outcome . However , the methods used were either invasive or had other limitations . The aim of this study was to perform intraoperative goal -directed therapy with a minimally invasive , easy to use device ( FloTrac/Vigileo ) , and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a st and ard management protocol . Methods In this r and omized , controlled trial 60 high-risk patients scheduled for major abdominal surgery were included . Patients were allocated into either an enhanced hemodynamic monitoring group using a cardiac index based intraoperative optimization protocol ( FloTrac/Vigileo device , GDT-group , n = 30 ) or a st and ard management group ( Control-group , n = 30 ) , based on st and ard monitoring data . Results The median duration of hospital stay was significantly reduced in the GDT-group with 15 ( 12 - 17.75 ) days versus 19 ( 14 - 23.5 ) days ( P = 0.006 ) and fewer patients developed complications than in the Control-group [ 6 patients ( 20 % ) versus 15 patients ( 50 % ) , P = 0.03 ] . The total number of complications was reduced in the GDT-group ( 17 versus 49 complications , P = 0.001 ) . Conclusions In high-risk patients undergoing major abdominal surgery , implementation of an intraoperative goal -directed hemodynamic optimization protocol using the FloTrac/Vigileo device was associated with a reduced length of hospital stay and a lower incidence of complications compared to a st and ard management protocol .Trial Registration Clinical trial registration information : Unique identifier : Purpose We aim ed to investigate the influence of perioperative goal -directed fluid therapy ( GDFT ) on the prognosis of elderly patients with gastric cancer and hypertension . Methods Sixty elderly patients ( > 60 years old ) with primary hypertension who received gastric cancer radical surgery and who were American Society of Anesthesiologists ( ASA ) class II or III were enrolled in the current study . Selected patients were divided r and omly into two arms , comprising a conventional intraoperative fluid management arm ( arm C , n=30 ) and a GDFT arm ( arm G , n=30 ) . Patients in arm C were infused with crystalloids or colloids according to the methods of Miller ’s Anesthesia ( 6th edition ) , while those in arm G were infused with 200 mL hydroxyethyl starch over 15 minutes under the FloTrac/Vigileo monitoring system , with stroke volume variation between 8 % and 13 % . Hemodynamics and tissue perfusion laboratory indicators in patients were recorded continuously from 30 minutes before the operation to 24 hours after the operation . Results Compared with arm C , the average intraoperative intravenous infusion quantity in arm G was significantly reduced ( 2,732±488 mL versus 3,135±346 mL , P<0.05 ) , whereas average colloid fluid volume was significantly increased ( 1,235±360 mL versus 760±280 mL , P<0.05 ) . In addition , there were more patients exhibiting intraoperatively and postoperatively stable hemodynamics and less patients with low blood pressure in arm G. Postoperative complications were less frequent , and the time of postoperative hospital stay shorter , in arm G. No significant differences were observed in mortality between the two arms . Conclusion Our research showed that GDFT  stabilized perioperative hemodynamics and reduced the occurrence of postoperative complications in elderly patients who underwent gastric cancer surgery BACKGROUND Patients with proximal femoral fracture ( PFF ) are at high risk of postoperative complications . Goal -directed haemodynamic treatment ( GDHT ) in other high-risk surgical patients reduces postoperative complications . We aim ed to compare effects of GDHT and routine fluid treatment ( RFT ) on postoperative outcomes after PFF surgery . METHODS PFF patients ( ≥70 yr ) were enrolled in this single-centre , open , r and omized , controlled , parallel-group superiority trial with concealed allocation using computer-generated r and omization . TREATMENTS ( i ) GDHT to attain oxygen delivery index > 600 ml min(-1 ) m(-2 ) using fluids and dobutamine and ( ii ) a protocol -guided RFT .  After 150 enrolled patients , the trial was stopped due to slow recruitment . The short-term primary outcome measure was the relative risk ( RR ) of postoperative complications ; secondary measures were ( i ) administered fluid levels , ( ii ) vasopressor requirements , and ( iii ) haemodynamic responses . RESULTS For the GDHT group , 74 and for the RFT group 75 patients were design ated . The RR of postoperative complications ( GDHT vs RFT ) was 0.79 ( 95 % confidence interval 0.54 - 1.16 ) ; the volumes of i.v . fluids decreased ( 1078 vs 1440 ml , P=0.01 ) ; fewer patients required treatment of hypotension ( 18.5 % vs 75 % , P<0.005 ) ; there were more patients with increased oxygen delivery at the end of operation ( 28 % vs 8 % , P=0.04 ) , but the haemodynamic goal was achieved in only 27 % of patients in the GDHT group . CONCLUSIONS The magnitude of risk reduction of postoperative complications is clinical ly relevant , but the trial was underpowered and the null hypothesis can not be rejected BACKGROUND Morbidity after major surgery is associated with low oxygen delivery . Haemodynamic therapy aim ed at increasing oxygen delivery in an effort to reduce oxygen debt , tissue injury , and morbidity , is controversial . The most appropriate target for this strategy is unclear and might have several off-target effects , including loss of neural (parasympathetic)-mediated cellular protection . We hypothesised that individualised oxygen delivery targeted haemodynamic therapy ( goal -directed therapy ) in high-risk surgical patients would reduce postoperative morbidity , while secondarily addressing whether goal -directed therapy affected parasympathetic function . METHODS In this multicentre , r and omised , double-blind , controlled trial , adult patients undergoing major elective surgery were allocated by computer-generated r and omisation to a postoperative protocol ( fluid , with and without dobutamine ) targeted to achieve their individual preoperative oxygen delivery value ( goal -directed therapy ) or st and ardised care ( control ) . Patients and staff were masked to the intervention . The primary outcome was absolute risk reduction ( ARR ) in morbidity ( defined by Clavien-Dindo grade II or more ) on postoperative day 2 . We also assessed a secondary outcome focused on parasympathetic function , using time-domain heart rate variability measures . Analyses were done on an intention-to-treat basis . The trial was registered with Controlled Clinical Trials ( number IS RCT N76894700 ) . FINDINGS We enrolled 204 patients between May 20 , 2010 , and Feb 12 , 2014 . Intention-to-treat analysis of the 187 ( 92 % ) patients who completed the trial intervention period showed that early morbidity was similar between goal -directed therapy ( 44 [ 46 % ] of 95 patients ) and control groups ( 49 [ 53 % ] of 92 patients ) ( ARR -7 % , 95 % CI -22 to 7 ; p=0·30 ) . Prespecified secondary analysis showed that 123 ( 66 % ) of 187 patients achieved preoperative oxygen delivery ( irrespective of intervention ) . These patients sustained less morbidity ( ARR 19 % , 95 % CI 3 - 34 ; p=0·016 ) , including less infectious complications  . Goal -directed therapy reduced parasympathetic activity postoperatively ( relative risk 1·33 , 95 % CI 1·01 - 1·74 ) . INTERPRETATION Achievement of preoperative oxygen delivery values in the postoperative phase was associated with less morbidity , but this was not affected by the use of an oxygen delivery targeted strategy . Reduced parasympathetic activity after goal -directed therapy was associated with the failure of this intervention to reduce postoperative morbidity . FUNDING Academy of Medical Sciences and Health Foundation Clinician Scientist Award There is continued controversy regarding the benefits of goal -directed fluid therapy , with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently . The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal -directed versus restrictive fluid therapy . Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3 . Patients were intraoperatively r and omised to either restrictive or Doppler-guided goal -directed fluid therapy . The primary outcome was length-of-stay ; secondary outcomes included complication rate , change in haemodynamic variables and fluid volumes .  One hundred patients , 50 in each group , were included in the analysis . Compared to restrictive therapy , goal -directed therapy result ed in a greater volume of intraoperative fluid , 2115 ( interquartile range 1350 to 2560 ) ml versus 1500 ( 1200 to 2000 ) ml , P=0.008 , and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery , 43.7 ( 16.3 ) to 54.2 ( 21.1 ) ml/m2 , P < 0.001 , in the latter group . Length-of-stay was similar , P=0.421 . The number of patients with any complication ( minor or major ) was similar ; 60 % ( 30 ) versus 52 % ( 26 ) , P=0.42 , or major complications , 1 ( 2 % ) versus 4 ( 8 % ) , P=0.36 , respectively . The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal -directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications Introduction Little is known about mortality rates following  general surgical procedures  in the United Kingdom . Deaths are most common in the ' high-risk ' surgical population consisting mainly of older patients , with coexisting medical disease , who undergo major surgery . Only limited data are presently available to describe this population . The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit ( ICU ) re source use . Methods Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre data base and the CHKS data base . High-risk surgical procedures were defined prospect ively as those for which the mortality rate was 5 % or greater . Results There were 4,117,727 surgical procedures ; 2,893,432 were elective ( 12,704 deaths ; 0.44 % ) and 1,224,295 were emergencies ( 65,674 deaths ; 5.4 % ) . A high-risk population of 513,924 patients was identified ( 63,340 deaths ; 12.3 % ) , which accounted for 83.8 % of deaths but for only 12.5 % of procedures . This population had a prolonged hospital stay ( median , 16 days 
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Though patients who received GDFT were infused more colloid ( p < 0.0001 ) , there is no increased risk of heart failure or pulmonary edema and renal failure .
Conclusion GDFT in major non- cardiac surgical patients has question able benefit over a st and ard care in terms of postoperative mortality , length of hospital stay and length of ICU stay .
However , incidence of all complications including wound infection , abdominal complications and postoperative hypotension is reduced