Costs Associated with Choice of Perioperative Intravenous Crystalloid among Adults Undergoing Cardiac Surgery

Abstract

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

Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review

“…This limits the clinical value of the results significantly, as non-patient-important outcomes (surrogate outcomes) are known to result in inflated estimates and increased risk of false-positive findings. 50,51 Only seven studies reported patient-centred outcome measures, 20,21,23,26,34,45,46 none of which were high-quality RCTs. Importantly, no studies reported data on adverse effects.…”

“…Regarding acetate, animal studies have shown a significant increase in plasma concentrations of up to 40 times the physiological level with even small volumes of acetate-based Six studies 20,21,23,26,34,46 Five studies found no statistically significant difference between groups 20,21,23,26,34 One study found OR for 90-day mortality of 0.96 (95% CI: 0.94e0.97) in the acetate-vs lactate-buffered groups 46 Hospital LOS Five studies 21,23,26,34,45 Two studies found increased hospital LOS in the lactate-vs acetate-buffered groups 26,34 One study found increased hospital LOS in the acetate-buffered group 45 Two studies found no difference between groups 21,23 ICU LOS Four studies 20,21,23,34 No studies reported a significant difference in ICU LOS between groups 20,21,23,34…”

“…Of the 29 included studies, a total of five clinical trials 20,21,23,26,34 and two observational studies 45,46 reported patient-centred outcome measures (e.g. mortality, length of stay [LOS] in ICU, return to ICU, days in ventilator, postoperative/infectious complications, and LOS in hospital).…”

“…Regarding mortality, five studies found no statistically significant difference between groups, 20,21,23,26,34 whereas one study found an odds ratio with 95% CI for 90-day mortality of 0.96 (95% CI: 0.94e0.97) in the acetate-vs lactate-buffered group. 46 Length of stay was addressed in six studies 20,21,23,26,34,45 with divergent results. Two studies found increased hospital LOS in the lactate-vs acetate-buffered group, 26,34 one found increased hospital LOS in the acetate-buffered group, 45 whilst the remaining two studies found no difference between groups.…”

“…46 Length of stay was addressed in six studies 20,21,23,26,34,45 with divergent results. Two studies found increased hospital LOS in the lactate-vs acetate-buffered group, 26,34 one found increased hospital LOS in the acetate-buffered group, 45 whilst the remaining two studies found no difference between groups. 21,23 No studies reported a statistically significant difference in ICU LOS between groups.…”