Intraoperative Adverse Events, Waste, and Costs Before and After Implementation of Intravenous Fluid Conservation During a National Shortage.

Abstract

Both medication shortages and hospital waste are important challenges in contemporary medicine. These challenges must be balanced to favor patient safety, which remains a fundamental goal of anesthesiology. This retrospective study, based on material delivery and provider-reported major adverse intraoperative cardiovascular events, evaluates the impact of a fluid conservation strategy in the operating room, implemented on October 10, 2024, after the 2024 nationwide IV fluid shortage caused by Hurricane Milton. A total of 46,893 patients were cared for in the included operating rooms from October 2023 to January, 2025. The fluid conservation strategy successfully decreased weekly delivery requirements for fluids (median [IQR]: 1936 [1668-2055] vs 862 [740-1155] mL per case, P < .01; mean difference -1050 mL; 95% CI -665 to -1435 mL). This decrease was paralleled with a decrease in weekly costs for both fluids and fluid tubing (19,618 [13,991-21,930] vs 12,578 [9391-13,424] $, P < .01; mean difference -6784; 95% CI -1737 to -11,831 $) as well as weight of weekly plastic waste created 221.2 [205.6-246.5] vs 138.6 [105.7-155.2] kg, P < .01; mean difference -77 kg; 95% CI -25.7 to -128.8 kg). The incidence of major adverse events and case cancelations did not change after the implementation of the fluid reduction strategy. Our mitigation strategy decreased fluid usage per case, related costs, and plastic waste generated from fluids and infusion tubing. Further research focused on patient outcomes is needed before implementing such a strategy into standard care practice.