title: Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte.
abstract: OBJECTIVE
  To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery.
  
  
  BACKGROUND
  0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery.
  
  
  METHODS
  An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9% saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models.
  
  
  RESULTS
  For the entire cohort, the in-hospital mortality was 5.6% in the saline group and 2.9% in the balanced group (P < 0.001). One or more major complications occurred in 33.7% of the saline group and 23% of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95% confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9% saline.
  
  
  CONCLUSIONS
  Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9% saline.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27705, USA. andrew.shaw@duke.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Scherer
authors.forename: Michael
authors.initials: M
authors.lastname: Duan
authors.forename: Carol R
authors.initials: CR
authors.lastname: Schermer
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002314:Cardioplegic Solutions / Q000009:adverse effects*; D002648:Child; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D004632:Emergency Medical Services; D005942:Gluconates / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D015636:Magnesium Chloride / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011189:Potassium Chloride / Q000009:adverse effects; D057216:Propensity Score; D012189:Retrospective Studies; D019346:Sodium Acetate / Q000009:adverse effects; D012965:Sodium Chloride / Q000009:adverse effects*; D014882:Water-Electrolyte Balance; D055815:Young Adult
chemical_list: D002314:Cardioplegic Solutions; D005942:Gluconates; C012499:Plasma-lyte 148; D015636:Magnesium Chloride; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride