A45Objectives: Patients undergoing cardiac surgery (CS) routinely receive intravenous (IV) crystalloids perioperatively (during and immediately post-surgery). A study using a large US electronic health record database, reported an association between the use of low-chloride IV crystalloids and improved outcomes. Here we examine the association between perioperative crystalloid choice and treatment costs among adults undergoing CS. MethOds: Patients who underwent CS between January 2009-June 2013 and received ≥ 500 mL of IV crystalloids within 1 day post-surgery, survived ≥ 1 day, and had recorded data on charges were included. Main exclusion criteria were hospital stay > 30 days and receipt of > 1 L IV fluids on the day before surgery. Patients were categorized as receiving either 0.9% saline exclusively as their primary IV fluid, Lactated Ringer's (LR), or a calcium-free balanced crystalloid (Plasma-Lyte (CF-BAL)). Outcomes were compared in three propensity-matched cohorts and included total cost, cost/day/patient, and length-of-stay (LOS). Costs were calculated using published cost-to-charge ratios. Results: In the propensitymatched cohorts (CF-BAL versus saline (n= 298 patients); CF-BAL versus LR (n= 516); LR versus saline (n= 2,930)), CF-BAL was associated with significantly lower total costs than either saline
SUMMARYIn an earlier article in this journal (June 1999) we discussed the risk that the presence of cardiac disease poses to patients undergoing non‐cardiac surgery. We outlined factors in the patient's medical history, examination findings and the value of various tests in arriving at an overall assessment of risk for any given patient. In this article we concentrate on the management of these patients as they undergo surgery itself. We shall consider what measures may usefully be employed in order to minimise the risk of an adverse cardiac event occurring in the perioperative period.
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