Outcomes and organ protection effects of perioperative precision venous access management strategies in patients undergoing complex hepatobiliary, pancreatic, splenic and abdominal great vascular surgery: a systematic review and meta-analysis.
- 1Outpatient & Emergency Department (Peripheral Intravenous Catheterization Nursing Clinic), The NO. Four People's Hospital of Yu Yao, Yu Yao City, Zhejiang Province, 315400, China.
- 2Department of Hepatobiliary, Pancreatic, Gastrointestinal, and Vascular Surgery, Yangming Hospital Affiliated to Ningbo University (Yuyao People's Hospital), No. 800, Chengdong Road, Yu Yao City, Zhejiang Province, 315400, China. [email protected].
Abstract
Background & aims
With continuous advances in surgical techniques, complex hepatobiliary pancreatic (HPB) and vascular surgical procedures are increasingly being applied clinically. Whilst such operations can improve patient prognosis, the extensive surgical trauma and severe physiological disruption they entail trigger intense physiological stress responses, significantly heightening the risk of perioperative organ injury. This has become a critical clinical challenge that impedes postoperative recovery and exacerbates the burden on healthcare systems. Current conventional fluid management strategies in clinical practice are primarily guided by static haemodynamic parameters. They lack dynamic adaptability to individual patient physiological reserves and surgical stress levels, readily leading to inadequate or excessive volume resuscitation, thereby exacerbating organ dysfunction. Precision Venous Access Management (PVAM) during the perioperative period represents an innovative therapeutic strategy integrating advanced haemodynamic monitoring, algorithm-guided therapy, and specialised access support. This approach overcomes the limitations of conventional management, offering a new direction for individualised perioperative care. This meta-analysis aims to systematically evaluate the impact of perioperative precision venous access management (PVAM) on organ-specific complication rates and clinical outcomes in patients undergoing complex hepatobiliary, pancreatic, and vascular surgery. It seeks to clarify its organ-protective value and clinical feasibility, providing high-quality evidence-based support for the clinical implementation of this strategy in high-risk surgical patients.Methods
Systematic searches were conducted in PubMed, Embase, the Cochrane Library, and Web of Science databases, with the search cutoff date set at 15 April 2024. Randomised controlled trials (RCTs) and prospective cohort studies comparing perioperative precision venous access management (PVAM) (integrating advanced haemodynamic monitoring, goal-directed therapy, and specialised access) with standard treatment in adults undergoing complex hepatobiliary-pancreatic or major vascular surgery were included. Primary outcomes comprised acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Data were synthesised using a random-effects model.Results
Fourteen studies involving 2,158 patients were included. Perioperative precision venous access management (PVAM) significantly reduced the incidence of AKI (RR=0.61, 95% CI 0.49-0.76; P<0.001) and CR-POPF (RR=0.69, 95% CI 0.54-0.88; P=0.002), while also reducing the overall complication rate (RR=0.76, 95% CI 0.65-0.89) and shortening hospital stay (MD=-2.4 days, 95% CI -3.8 to -1.0).Conclusions
The perioperative precision venous access management (PVAM) strategy demonstrates significant renal and pancreatic protective effects, promoting postoperative recovery in patients undergoing complex hepatobiliary, pancreatic, and vascular surgery, thereby supporting its integration into clinical practice.
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BibTeX
@article{zhu2026outcomes,
title = {{Outcomes and organ protection effects of perioperative precision venous access management strategies in patients undergoing complex hepatobiliary, pancreatic, splenic and abdominal great vascular surgery: a systematic review and meta-analysis.}},
author = {Jun Zhu and Sufang Fang},
journal = {BMC surgery},
year = {2026},
month = aug,
doi = {10.1186/s12893-026-04070-0},
url = {https://europepmc.org/article/MED/42963575},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Outcomes and organ protection effects of perioperative precision venous access management strategies in patients undergoing complex hepatobiliary, pancreatic, splenic and abdominal great vascular surgery: a systematic review and meta-analysis.
AU - Jun Zhu
AU - Sufang Fang
PY - 2026
DA - 2026/08/04
JO - BMC surgery
DO - 10.1186/s12893-026-04070-0
UR - https://europepmc.org/article/MED/42963575
AB - Background & aims With continuous advances in surgical techniques, complex hepatobiliary pancreatic (HPB) and vascular surgical procedures are increasingly being applied clinically. Whilst such operations can improve patient prognosis, the extensive surgical trauma and severe physiological disruption they entail trigger intense physiological stress responses, significantly heightening the risk of perioperative organ injury. This has become a critical clinical challenge that impedes postoperative recovery and exacerbates the burden on healthcare systems. Current conventional fluid management strategies in clinical practice are primarily guided by static haemodynamic parameters. They lack dynamic adaptability to individual patient physiological reserves and surgical stress levels, readily leading to inadequate or excessive volume resuscitation, thereby exacerbating organ dysfunction. Precision Venous Access Management (PVAM) during the perioperative period represents an innovative therapeutic strategy integrating advanced haemodynamic monitoring, algorithm-guided therapy, and specialised access support. This approach overcomes the limitations of conventional management, offering a new direction for individualised perioperative care. This meta-analysis aims to systematically evaluate the impact of perioperative precision venous access management (PVAM) on organ-specific complication rates and clinical outcomes in patients undergoing complex hepatobiliary, pancreatic, and vascular surgery. It seeks to clarify its organ-protective value and clinical feasibility, providing high-quality evidence-based support for the clinical implementation of this strategy in high-risk surgical patients.Methods Systematic searches were conducted in PubMed, Embase, the Cochrane Library, and Web of Science databases, with the search cutoff date set at 15 April 2024. Randomised controlled trials (RCTs) and prospective cohort studies comparing perioperative precision venous access management (PVAM) (integrating advanced haemodynamic monitoring, goal-directed therapy, and specialised access) with standard treatment in adults undergoing complex hepatobiliary-pancreatic or major vascular surgery were included. Primary outcomes comprised acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). Data were synthesised using a random-effects model.Results Fourteen studies involving 2,158 patients were included. Perioperative precision venous access management (PVAM) significantly reduced the incidence of AKI (RR=0.61, 95% CI 0.49-0.76; P<0.001) and CR-POPF (RR=0.69, 95% CI 0.54-0.88; P=0.002), while also reducing the overall complication rate (RR=0.76, 95% CI 0.65-0.89) and shortening hospital stay (MD=-2.4 days, 95% CI -3.8 to -1.0).Conclusions The perioperative precision venous access management (PVAM) strategy demonstrates significant renal and pancreatic protective effects, promoting postoperative recovery in patients undergoing complex hepatobiliary, pancreatic, and vascular surgery, thereby supporting its integration into clinical practice.
SN - 1471-2482
ER -