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Trials on perioperative goal\u2010directed therapy show conflicting results. We aimed to conduct a systematic review and meta\u2010analysis to investigate the benefits and harms of perioperative goal\u2010directed therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pub<jats:styled-content style=\"fixed-case\">MED<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> EMBASE<\/jats:styled-content>, Web of Science and Cochrane Library were searched. Trials were included if they had a perioperative goal\u2010directed therapy protocol. The primary outcome was all\u2010cause mortality. The first secondary outcome was serious adverse events excluding mortality. Risk of bias was assessed, and <jats:styled-content style=\"fixed-case\">GRADE<\/jats:styled-content> was used to evaluate quality of evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and twelve randomised trials were included of which one trial (1%) had low risk of bias. Included trials varied in patients: types of surgery which was expected due to inclusion criteria; in intervention and comparison: timing of intervention, monitoring devices, haemodynamic variables, target values, use of fluids, vasopressors and\/or inotropes as well as combinations of these within protocols; and in outcome: mortality was reported in 87 trials (78%). Due to substantial clinical\u00a0heterogeneity also within the various types of surgery a meta\u2010analysis of data, including subgroup analyses, as defined in our protocol was considered inappropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinical heterogeneity in patients, interventions and outcomes in perioperative goal\u2010directed therapy trials is too large to perform meta\u2010analysis on all trials. Future trials and meta\u2010analyses highly depend on universally agreed definitions on aspects beyond type of surgery of the complex intervention and its evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.13212","type":"journal-article","created":{"date-parts":[[2018,7,6]],"date-time":"2018-07-06T08:16:00Z","timestamp":1530864960000},"page":"1340-1355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Perioperative goal\u2010directed therapy: A systematic review without meta\u2010analysis"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0589-8879","authenticated-orcid":false,"given":"Thomas","family":"Kaufmann","sequence":"first","affiliation":[{"name":"Department of Anesthesiology University Medical Center Groningen University of Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon P.","family":"Clement","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University Medical Center Groningen University of Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W. 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