Background &amp; aims <p>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.</p> Methods <p>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.</p> Results <p>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&lt;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).</p> Conclusions <p>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.</p>