Electrolyte Analysis and Replacement: Challenging a Paradigm in Surgical Patients

Area of Science:

• Medical Economics
• Clinical Practice
• Patient Monitoring

Background:

• Postoperative patients frequently experience electrolyte imbalances.
• Current practice often involves electrolyte replacement in stable, non-intensive care unit (ICU) patients, despite a lack of proven benefit.
• The cost-effectiveness of these interventions is not well-established.

Purpose of the Study:

• To retrospectively analyze the frequency and cost of electrolyte analysis and replacement in perioperative patients.
• To evaluate the economic impact of routine electrolyte monitoring and treatment in stable, non-critically ill surgical patients.

Main Methods:

• Retrospective cost analysis of electronic medical records and pharmacy data from a university academic medical center in 2016.
• Included perioperative patients meeting specific criteria (e.g., stable, not in ICU, normal renal function).
• Calculated costs for laboratory tests (basic metabolic panel [BMP], ionized calcium [Ca], magnesium [Mg], phosphorus [P]) and electrolyte replacements (potassium chloride [KCl], Mg, Ca, P), including nursing costs.

Main Results:

• 113 patients were analyzed over 11 months, with a mean length of stay of 4 days and mean age of 54 years.
• Electrolyte analysis orders (n=1,045) cost $6,978, with BMP being the most frequent test.
• Electrolyte replacements (n=683) cost $1,780, with Mg and KCl being most common. Total associated nursing costs were $7,782.
• The average cost per case was $146, with BMP, potassium pharmacy charges, and nursing costs being the most significant contributors.

Conclusions:

• There is limited evidence to support routine electrolyte analysis and replacement in stable, asymptomatic, non-critically ill postoperative patients.
• These practices are prevalent and represent a substantial cost burden within healthcare systems.
• Further research is warranted to determine the clinical and economic justification for these interventions.