Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit
Joseph Rabin1, Timothy Meyenburg2, Ashleigh V Lowery3
1R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
Insights
Restricting albumin use in cardiac surgery intensive care units significantly reduced costs and utilization without impacting patient outcomes. This strategy demonstrates feasibility and safety for maintaining quality of care while lowering expenses.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Health Economics
Background:
- Volume expansion is common post-cardiac surgery, often involving albumin.
- High albumin costs prompted a study to reduce its use.
- This research investigates the impact of limiting albumin in a cardiac surgery ICU.
Purpose of the Study:
- To analyze the effects of restricted albumin administration in a cardiac surgery intensive care unit.
- To assess the feasibility, safety, and economic impact of albumin utilization guidelines.
Main Methods:
- Retrospective analysis of albumin use in a cardiac surgery ICU from April 2014 to April 2015.
- Implementation of restrictive guidelines in January 2015, limiting albumin to specific patient groups.
- Comparison of albumin utilization, mortality, ventilator days, transfusion rates, and length of stay before and after guideline implementation.
Main Results:
- Albumin utilization decreased significantly from 280 to 101 monthly doses post-guidelines (p < 0.001).
- A trend towards reduced ventilator days was observed.
- No significant changes in mortality, length of stay, or transfusion requirements were found.
- Monthly wholesale cost savings exceeded $45,000.
Conclusions:
- Restricting albumin in cardiac surgery ICUs is feasible and safe.
- Significant cost and utilization reductions were achieved without compromising patient morbidity or mortality.
- This approach offers a strategy for cost reduction while preserving care quality.
Background:
Volume expansion is often necessary after cardiac surgery, and albumin is often administered. Albumin's high cost motivated an attempt to reduce its utilization. This study analyzes the impact limiting albumin infusion in a cardiac surgery intensive care unit.
Methods:
This retrospective study analyzed albumin use between April 2014 and April 2015 in patients admitted to a cardiac surgery intensive care unit. During the first 9 months, there were no restrictions. In January 2015, institutional guidelines limited albumin use to patients requiring more than 3 L crystalloid in the early postoperative period, hypoalbuminemic patients, and to patients considered fluid overloaded. Albumin utilization was obtained from pharmacy records and compared with outcome quality metrics.
Results:
In all, 1,401 patients were admitted over 13 months. Albumin use, mortality, ventilator days, patients receiving transfusions, and length of stay were compared for 961 patients before and 440 patients after guidelines were initiated. After restrictive guidelines were instituted, albumin utilization was reduced from a mean of 280 monthly doses to a mean of 101 monthly doses (p < 0.001). There was also a trend toward reduced ventilator days. Mortality, length of stay, and transfusion requirements demonstrated no significant change. Based on an average wholesale price and an average monthly reduction of 180 albumin doses, the cardiac surgery intensive care unit demonstrated more than $45,000 of wholesale savings per month after restrictions were implemented.
Conclusions:
Albumin restriction in the cardiac surgery intensive care unit was feasible and safe. Significant reductions in utilization and cost with no changes in morbidity or mortality were demonstrated. These findings may provide a strategy for reducing cost while maintaining quality of care.
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