Albumin Versus Crystalloids in Postcardiac Surgery Fluid Resuscitation: A Cost and Safety Analysis

Intravenous fluids are commonly used in postcardiac surgery to maintain or increase intravascular volume. While volume expansion after cardiac surgery is often necessary, the optimal fluid type to use is not established.

The objective of the study is to evaluate cost-savings and clinical outcomes of an albumin minimization protocol for postcardiac surgery fluid resuscitation at a surgical intensive care unit in a community teaching hospital.

This was a single-center retrospective cohort study of patients who received fluid resuscitation after open heart coronary artery bypass surgery or valvular surgery while on cardiopulmonary bypass at a community teaching hospital between February 2021 and May 2022. Cohorts were split up prior to the implementation of an albumin minimization protocol that was implemented in September 2021. The primary outcome was the amount of albumin or crystalloid fluids received after surgery, and the overall cost of intravenous fluids after surgery. Secondary outcomes included 30-day mortality, acute kidney injury, hours on oxygen support, hours on vasopressors, multiple vasopressors used, perioperative blood product transfusions, and 72-hour surgery take back.

Of 434 total patients evaluated, 400 patients met criteria for inclusion. Baseline characteristics were balanced between the 2 groups. Average surgical time was shorter in the postprotocol arm. Per patient use of albumin decreased by 27.1 g (22.8-31.4) while crystalloid fluid use increased by 1 L (0.9-1.2) after implementation of the albumin minimization protocol. Average cost savings were approximately $178 per surgery. No statistically significant difference was seen in any of the secondary safety and efficacy outcomes.

This study adds to the body of literature suggesting that the use of an albumin minimization protocol after open heart cardiac surgery was safe and effective. A significant reduction in cost and utilization of albumin was seen in the study without affecting patient outcomes.