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J Clin Med. 2018 Aug 21;7(9). pii: E227. doi: 10.3390/jcm7090227.

Perioperative Cumulative Fluid Balance and Its Association with an Increase in Costs after Major Surgery.

Oh TK1, Hwang JW2,3, Jeon YT4,5, Do SH6,7.

Author information

1
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. airohtak@hotmail.com.
2
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. jungwon@snubh.org.
3
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. jungwon@snubh.org.
4
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. ytjeon@snubh.org.
5
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. ytjeon@snubh.org.
6
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea. shdo@snu.ac.kr.
7
Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. shdo@snu.ac.kr.

Abstract

Positive fluid balance (FB) during the perioperative period may increase the incidence of postoperative complications, which may lead to longer hospitalization and higher hospital costs. However, a definitive association between positive FB and hospital costs has not yet been established. This retrospective observational study examined the association between perioperative FB and hospital costs of patients who underwent major surgical procedures. Medical records of patients who underwent major surgery (surgery time >2 h, estimated blood loss >500 mL) from January 2010 to December 2017 were analyzed to determine the associations between calculated FB (%, total input fluid-output fluid in liter/weight (kg) at admission) and total hospital cost ($). The analysis included medical data of 7010 patients. Multivariable linear regression analyses showed that a 1% increase in FB in postoperative day (POD) 0 (24 h), 0⁻1 (48 h), 0⁻2 (72 h), and 0⁻3 (96 h) significantly increased the total cost by $967.8 (95% confidence interval [CI]: 803.4⁻1132.1), $688.8 (95% CI: 566.3⁻811.2), $591 (95% CI: 485.7⁻696.4), and $434.2 (95% CI: 349.4⁻519.1), respectively (all p < 0.001). Perioperative cumulative FB was positively associated with hospital costs of patients who underwent major surgery.

KEYWORDS:

costs and cost analysis; general surgery; hospitals

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