Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte

Andrew D. Shaw, Sean M. Bagshaw, Stuart L. Goldstein, Lynette A. Scherer, Michael Duan, Carol R. Schermer, John A. Kellum

Research output: Contribution to journalArticle

378 Citations (Scopus)

Abstract

Objective: To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. Background: 0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery. Methods: An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9% saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models. RESULTS:: For the entire cohort, the in-hospital mortality was 5.6% in the saline group and 2.9% in the balanced group (P < 0.001). One or more major complications occurred in 33.7% of the saline group and 23% of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95% confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9% saline. Conclusions: Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9% saline.

Original languageEnglish (US)
Pages (from-to)821-829
Number of pages9
JournalAnnals of Surgery
Volume255
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

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Acidosis
Mortality
Morbidity
Ambulatory Surgical Procedures
Databases
Calcium
Hospital Mortality
Blood Transfusion
Electrolytes
Observational Studies
Renal Insufficiency
Dialysis
Logistic Models
Odds Ratio
Confidence Intervals
Plasma-lyte 148
Infection
crystalloid solutions
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Shaw, A. D., Bagshaw, S. M., Goldstein, S. L., Scherer, L. A., Duan, M., Schermer, C. R., & Kellum, J. A. (2012). Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte. Annals of Surgery, 255(5), 821-829. https://doi.org/10.1097/SLA.0b013e31825074f5

Major complications, mortality, and resource utilization after open abdominal surgery : 0.9% saline compared to plasma-lyte. / Shaw, Andrew D.; Bagshaw, Sean M.; Goldstein, Stuart L.; Scherer, Lynette A.; Duan, Michael; Schermer, Carol R.; Kellum, John A.

In: Annals of Surgery, Vol. 255, No. 5, 05.2012, p. 821-829.

Research output: Contribution to journalArticle

Shaw, AD, Bagshaw, SM, Goldstein, SL, Scherer, LA, Duan, M, Schermer, CR & Kellum, JA 2012, 'Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to plasma-lyte', Annals of Surgery, vol. 255, no. 5, pp. 821-829. https://doi.org/10.1097/SLA.0b013e31825074f5
Shaw, Andrew D. ; Bagshaw, Sean M. ; Goldstein, Stuart L. ; Scherer, Lynette A. ; Duan, Michael ; Schermer, Carol R. ; Kellum, John A. / Major complications, mortality, and resource utilization after open abdominal surgery : 0.9% saline compared to plasma-lyte. In: Annals of Surgery. 2012 ; Vol. 255, No. 5. pp. 821-829.
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abstract = "Objective: To assess the association of 0.9{\%} saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. Background: 0.9{\%} saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery. Methods: An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9{\%} saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models. RESULTS:: For the entire cohort, the in-hospital mortality was 5.6{\%} in the saline group and 2.9{\%} in the balanced group (P < 0.001). One or more major complications occurred in 33.7{\%} of the saline group and 23{\%} of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95{\%} confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9{\%} saline. Conclusions: Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9{\%} saline.",
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T1 - Major complications, mortality, and resource utilization after open abdominal surgery

T2 - 0.9% saline compared to plasma-lyte

AU - Shaw, Andrew D.

AU - Bagshaw, Sean M.

AU - Goldstein, Stuart L.

AU - Scherer, Lynette A.

AU - Duan, Michael

AU - Schermer, Carol R.

AU - Kellum, John A.

PY - 2012/5

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N2 - Objective: To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. Background: 0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery. Methods: An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9% saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models. RESULTS:: For the entire cohort, the in-hospital mortality was 5.6% in the saline group and 2.9% in the balanced group (P < 0.001). One or more major complications occurred in 33.7% of the saline group and 23% of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95% confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9% saline. Conclusions: Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9% saline.

AB - Objective: To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. Background: 0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery. Methods: An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9% saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models. RESULTS:: For the entire cohort, the in-hospital mortality was 5.6% in the saline group and 2.9% in the balanced group (P < 0.001). One or more major complications occurred in 33.7% of the saline group and 23% of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95% confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9% saline. Conclusions: Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9% saline.

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