Twenty-six RCTs (4,188 participants) were included in the review. Nine RCTs were rated as very unlikely to have bias, eight as unlikely to have bias and nine as being at high risk of bias.
Surgical site infections (18 RCTs): Statistically significantly fewer episodes were reported by patients who received perioperative goal-directed therapy compared to standard haemodynamic management (OR 0.58, 95% CI 0.46 to 0.74, NNT 24, 95% CI 16.4 to 42.8).
Pneumonia (15 RCTs): Perioperative goal-directed therapy was associated with significantly fewer episodes of postoperative pneumonia (OR 0.71, 95% CI 0.55 to 0.92, NNT 34, 95% CI 20.8 to 91.6).
Catheter-related bloodstream infections (five RCTs): There were no statistically significant differences between treatment groups in the incidence of catheter-related bloodstream infections.
Urinary tract infections (10 RCTs): Goal-directed therapy was associated with significantly reduced incidence of urinary tract infections (OR 0.44, 95% CI 0.22 to 0.88, NNT 25, 95% CI 14.6 to 78.7).
Sensitivity analyses and subgroup analyses did not significantly alter the findings (as reported in the review). There was no evidence of significant statistical heterogeneity for any analyses.
All infectious episodes (26 RCTs): Similar results, which favoured goal-directed therapy, were found for the development of all infections (OR 0.40, 95% CI 0.28 to 0.58, NNT 12, 95% CI 9.0 to 16.1). There was evidence of significant statistical heterogeneity and inconsistency.