(224) The Comparison of Crystalloids and 5% Albumin for Post-Cardiac Surgery Fluid Resuscitation

Introduction: Patients undergoing cardiac surgery often require post-operative volume expansion. The type of fluid used for volume expansion remains debated between crystalloids and colloids. The purpose of this study is to evaluate the impact of crystalloid fluid administration compared to 5% albumin for post-cardiac surgery resuscitation on the incidence of adverse events.

Methods: This was a single-center, retrospective study that reviewed post-cardiac surgery patients who received 5% albumin vs crystalloids for post-operative fluid resuscitation. The primary outcome measured the incidence of ≥1 adverse event as a composite outcome of acute heart failure, acute kidney injury, new onset arrhythmia, and volume overload. Secondary outcomes measured the incidences of each adverse effect measured in the primary outcome, total fluid volume administered post-operatively, in-hospital mortality, length of stay, and cost. Data was analyzed using descriptive statistics, Chi-squared, and Mann-Whitney tests via SAS® Viya.

Results: One hundred patients’ electronic medical records were reviewed. No statistically significant differences in baseline characteristics were noted. The primary outcome did not demonstrate a statistically significant difference in the presence of at least 1 adverse event (80% vs 89.8%, p=0.174). For secondary outcomes, the presence of volume overload on post-operative day 3 or later was statistically significant (54% vs 77.6%, p=0.021), but both groups required approximately 2.5 L (p=0.546) of fluid resuscitation at 72 hours. All other secondary outcomes were similar between the two groups. The average cost was statistically significant in comparing the pre-group vs the post-group ($532.60 vs $12.04, p< 0.0001).

Conclusions: Use of 5% albumin compared to crystalloids in post-cardiac surgery fluid resuscitation did not demonstrate differences in the incidence of adverse events. While there was a difference noted in the incidence of post-operative volume overload, there was no statistically significant difference in any other outcome measured except for cost. The use of crystalloids in post-cardiac surgery patients for volume expansion may provide a cost-saving opportunity without increasing adverse events in this patient population.