title: Variability in practice and factors predictive of total crystalloid administration during abdominal surgery: retrospective two-centre analysis.
abstract: BACKGROUND
  Variation in clinical practice in the perioperative environment and intensive care unit is a major challenge facing modern medicine. The objective of the present study was to analyse intraoperative crystalloid administration practices at two academic medical centres in the USA.
  
  
  METHODS
  We extracted clinical data from patients undergoing intra-abdominal procedures performed at UC Irvine (UCI) and Vanderbilt University (VU) Medical Centres. Limiting data to uncomplicated elective surgery with minimal blood loss, we quantified variability in fluid administration within individual providers, between providers, and between types of procedures using a corrected coefficient of variation (cCOV). Regression was performed using a general linear model to determine factors most predictive of fluid administration.
  
  
  RESULTS
  For provider analysis and model building, 1327 UCI and 4585 VU patients were used. The average corrected crystalloid infusion rate across all providers at both institutions was 7.1 (sd 4.9) ml kg(-1) h(-1), an overall cCOV of 70%. Individual providers ranged from 2.3 (sd 3.7) to 14 (sd 10) ml kg(-1) h(-1). The final regression model strongly favoured personnel as predictors over other patient predictors.
  
  
  CONCLUSIONS
  Wide variability in crystalloid administration was observed both within and between individual anaesthesia providers, which might contribute to variability in surgical outcomes.
authors.affiliation: Department of Anesthesiology & Perioperative Care, UCI Medical Center, 101 the City Drive South, Orange, CA, USA Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Hospices Civils de Lyon, 60 avenue du Doyen Lepine, Bron 69300, France.
authors.forename: M
authors.initials: M
authors.lastname: Lilot
authors.affiliation: Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Department of Anesthesiology & Perioperative Care, UCI Medical Center, 101 the City Drive South, Orange, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology & Perioperative Care, UCI Medical Center, 101 the City Drive South, Orange, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Harrington
authors.affiliation: Department of Anesthesiology & Perioperative Care, UCI Medical Center, 101 the City Drive South, Orange, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cannesson
authors.affiliation: Department of Anesthesiology & Perioperative Care, UCI Medical Center, 101 the City Drive South, Orange, CA, USA jrinehar@uci.edu.
authors.forename: J
authors.initials: J
authors.lastname: Rinehart
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: fluid therapy; resuscitation; safety