Clinical Pharmacist Specialist Grady Health System
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Introduction: Limited data exists to guide optimal postoperative fluid resuscitation in cardiac surgery patients. Albumin is frequently used despite higher costs and unclear benefits. This analysis evaluated the cost-benefit of albumin versus crystalloid resuscitation by comparing drug costs and financial impact of intensive care unit (ICU) length of stay (LOS).
Methods: This retrospective chart review included adult post cardiac surgery patients that received either albumin or crystalloid from June 2019 to December 2023; patients with an ICU stay of less than 24 hours were excluded. Fluid volumes and associated drug costs were collected for the first 72 hours postoperatively. A cost-benefit analysis compared drug and ICU costs between groups. ICU costs were estimated by multiplying median ICU LOS by $4000/day based on national averages. Mann-Whitney U test was used to compare continuous variables. Descriptive statistics were used to characterize the data.
Results: Of the 177 patients included, 80 received albumin and 97 received crystalloid for postoperative resuscitation. Median ICU LOS was longer in the albumin group (median: 4.0 days [IQR 3.0–6.0]) compared to crystalloid (3.0 days [IQR 2.0–4.0]; p=0.002 ). Median drug cost per patient through post-operative day three was higher with albumin ($195.00 [IQR $130.00–$267.31]) versus crystalloid ($37.79 [IQR $21.36–$55.40]; p< 0.001). Estimated median ICU cost was $16,000 for albumin and $12,000 for crystalloid patients. Total median cost combining drug and ICU costs was $16,195 for albumin and $12,038 for crystalloid, reflecting an estimated additional $4,157 per patient associated with albumin resuscitation.
Conclusions: In this single-institution cohort, albumin use was associated with longer ICU LOS and higher drug costs, leading to increased total median patient costs compared to crystalloids. These findings highlight potential economic disadvantages of routine albumin use for postoperative resuscitation. Further prospective studies are needed to guide fluid choice based on clinical and economic outcomes.
