Analysis of Surgical Outcomes During a Period of Intravenous Fluid Restriction as a Result of a National Shortage.

Abstract

Hurricane Helene severely damaged the Baxter Pharmaceutical Plant in North Cove, North Carolina, in the fall of 2024, resulting in a national shortage of IV fluids. Our institution implemented an IV fluid restriction (IVFR) protocol to conserve supply across many domains of the hospital, including the perioperative space. Gynecologic, plastic, urologic, and general surgery procedures performed during the IVFR period were reviewed in our local NSQIP and MBSAQIP datasets. These cases were matched to historical controls from the pre-IVFR period using random 1:1 propensity score matching of the procedure and the 9 top NSQIP comorbid risk factors for overall morbidity. Perioperative and 30-day outcomes were then compared between the separate cohorts. There were 2,028 matched patients with 1,014 in each group. Patients had a mean age of 55.4 years, were 76.7% women, 91.8% White, and 6.8% Black. Procedures and comorbidities were well matched. There was no significant difference between the pre-IVFR and IVFR periods in length of stay, blood transfusion, hospital mortality, 30-day mortality, 30-day readmission, 30-day unplanned return to the operating room, and 30-day morbidity (including surgical site infection, dehiscence, renal insufficiency or failure, pneumonia, respiratory failure, venous thromboembolism, cardiac arrest or infarct, and stroke). Institutional data confirmed a decrease in IV fluid use and demonstrated lowered costs during the IVFR period. Perioperative IVFR for gynecologic, urologic, plastic, and general surgery operations does not negatively impact postoperative outcomes. Efforts should be made to revise perioperative fluid administration protocols to reduce hospital costs and waste without compromising patient care.