Perioperative Fluid Utilisation Variability and Association with Outcomes
Research article: (Ann Surg 2016;263:502–510)
The aim of this study was to investigate the role of the perioperative fluid therapy on the overall outcomes of surgical treatments (i.e. costs and complications). The study included three patient groups: 84 722 colon, 22 178 rectal, and 548 526 primary hip or knee replacement surgical patients. The research population was gathered from The Premier Research Database in the US.
The study shows significant associations between high fluid volume given on the day of the surgery with both the increased length of stay and the increased total costs. High fluid utilisation was associated with the increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilisation was also associated with worse outcomes. The authors underline the importance of fluid optimisation for improving the outcomes of the surgical treatments.
The Economic Burden of Hyponatremia: Systematic Review and Meta-Analysis
Research article: (Am J Med 2016;129(8):823-835.e4.)
Hyponatremia is the most common electrolyte abnormality observed in clinical practice. The economical impact of hyponatremia has remained unclear, though several studies suggest increased costs and prolonged hospital stay.
This extensive meta-analysis consisted of 46 studies that compared hospital length of stay and cost between patients with and without hyponatremia. A study population encompassed almost four million patients and 19.2% among these were hyponatremic.
Hyponatremia was found to be an important reason for a prolonged hospital length. It also increases the risk of readmission in certain patient groups. As a conclusion, hyponatremia causes increased costs for healthcare. For instance, in the US, the direct medical costs of hyponatremia were estimated up to $3.5 billion annually.
Intravenous infusion is a very common treatment procedure in the hospital wards
Research article: (Am J Hosp Pharm. 1985;42:328-31)
Intravenous infusion is typically delivered without any electronic device or supervision even nowadays. In addition, the infusion rate and the administered fluid volume are typically estimated visually.
This study was conducted to define the accuracy of gravity flow i.v-infusion systems. A total of 509 observations of the infusion rate were recorded during the study. The main results of the study were alarming. Less than 15% of the observations were within ± 10% of the desired drop rates, while only 21% of the observations fell within ± 20% of the desired drop rates.
To improve the accuracy and quality of the intravenous infusion therapy, better monitoring practices and routine use of the electronic infusion devices were recommended.