Variability in Net Fluid Administration: The Consistency of Inconsistency

Abstract

Despite advancements in surgical techniques and peri-operative care, fluid therapy has remained largely arbitrary. Goal-directed fluid therapy that optimized stroke volume and stroke volume variation has been shown to reduce adverse outcomes associated with excessive or insufficient fluid administration. Adequate peri-operative fluid administration can contribute to reduced morbidity, length of stay, and total cost per patient for hospitals. At Banner University Medical Tucson fluid therapy is not guided by consistent protocol or hemodynamic monitoring devices. The aim of this study was to characterize the patterns in practice for anesthesiologists at this institution. Data from anesthesia records was retrospectively collected from a patient population stratified into three surgical study groups: Hyperthermic Intraperitoneal Chemotherapy (HIPEC), Whipple’s procedures/pancreatectomies, and cardiopulmonary bypass (CPB). Net fluid administration (NFA) in ml*kg-1 *h-1. was calculated for each subject and variation was described between providers, within providers, and between surgical study groups. The study showed significant difference in NFA between surgical study groups. A pattern of large variability between and within providers was established in each surgical study group. The most variability was in the HIPEC study group, followed by the Whipple’s procedure/pancreatectomy study group. The least variation between providers and within providers was found in the CPB study group. According to the results from this review, there is justified need to implement a quality improvement study on protocoled and goal-directed fluid therapy at Banner University Medical Center Tucson.