Abstract
Positive fluid balance (FB) during the perioperative period may increase the incidence of postoperative complications, which may lead to longer hospitalization and higher hospital costs. However, a definitive association between positive FB and hospital costs has not yet been established. This retrospective observational study examined the association between perioperative FB and hospital costs of patients who underwent major surgical procedures. Medical records of patients who underwent major surgery (surgery time >2 h, estimated blood loss >500 mL) from January 2010 to December 2017 were analyzed to determine the associations between calculated FB (%, total input fluid—output fluid in liter/weight (kg) at admission) and total hospital cost ($). The analysis included medical data of 7010 patients. Multivariable linear regression analyses showed that a 1% increase in FB in postoperative day (POD) 0 (24 h), 0–1 (48 h), 0–2 (72 h), and 0–3 (96 h) significantly increased the total cost by $967.8 (95% confidence interval [CI]: 803.4–1132.1), $688.8 (95% CI: 566.3–811.2), $591 (95% CI: 485.7–696.4), and $434.2 (95% CI: 349.4–519.1), respectively (all p < 0.001). Perioperative cumulative FB was positively associated with hospital costs of patients who underwent major surgery.
Highlights
Perioperative fluid therapy is an important factor that may affect the prognosis of patients undergoing surgery [1,2,3] and, it is an indispensable issue in clinical practice [4]
Perioperative fluid strategy to prevent positive fluid balance (FB) is an important factor that is associated with postoperative complications, length of hospitalization, and hospital costs of a surgical population
Our finding that positive FB is associated with an increase in hospital costs after major surgery is consistent with the findings of previous studies [16,17,18]
Summary
Perioperative fluid therapy is an important factor that may affect the prognosis of patients undergoing surgery [1,2,3] and, it is an indispensable issue in clinical practice [4]. Perioperative fluid strategy to prevent positive FB is an important factor that is associated with postoperative complications, length of hospitalization, and hospital costs of a surgical population. Studies have begun to use weight-based FB (%), which considers fluid input value, and the amount of fluid output and patients’ weight at admission [11,12]. Such FB calculations in percentages using patients’ weight have been effectively used in the fluid management of critically ill or pediatric patients, who are more sensitive to fluid imbalance.
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