Association Between a Shortage of Normal Saline and In-Hospital Outcomes Among Individuals With Febrile Neutropenia

Background: Normal saline (NS) is a vital resource used to care for patients with febrile neutropenia (FN). A 2017 shortage in NS driven by Hurricane Maria raised concerns about patient outcomes. Objective: This study aimed to evaluate the impact of this shortage on in-hospital mortality and the length of stay (LOS) among adults with FN. Methods: The National Inpatient Sample database was used to identify adult FN encounters. Two cohorts were defined: a pre-shortage group (November 2016-March 2017) and a shortage group (November 2017-March 2018). In-hospital mortality was the primary outcome, and LOS was secondary. Results: We identified 19 425 encounters with FN in the dataset, 9584 occurring pre-shortage and 9841 occurring during the shortage. Cohorts were similar in age, sex, and race. Small but statistically significant differences were observed in primary payer distribution (P = 0.022) and hospital size (P = 0.037). In-hospital mortality was similar between cohorts (7.1% vs 6.9). Mean LOS was also similar during the pre-shortage vs shortage periods (10.1 ± 12.7 vs 10.2 ± 13.0 days). Adjusted analyses demonstrated no differences in mortality (aOR = 1.01; 95% CI = 0.90-1.13) or LOS (mean difference = 0.1 days; 95% CI = -0.14 to 0.38). Conclusion: Mortality and LOS were stable across pre-shortage and shortage periods in patients with FN despite the national NS shortage. While such shortages may disproportionately affect patients with conditions that rely heavily on supportive fluids and rapid intravenous medication administration, this study did not observe statistically significant negative impacts on patient outcomes.