title: Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit.
abstract: BACKGROUND
  Volume expansion is often necessary after cardiac surgery, and albumin is often administered. Albumin's high cost motivated an attempt to reduce its utilization. This study analyzes the impact limiting albumin infusion in a cardiac surgery intensive care unit.
  
  
  METHODS
  This retrospective study analyzed albumin use between April 2014 and April 2015 in patients admitted to a cardiac surgery intensive care unit. During the first 9 months, there were no restrictions. In January 2015, institutional guidelines limited albumin use to patients requiring more than 3 L crystalloid in the early postoperative period, hypoalbuminemic patients, and to patients considered fluid overloaded. Albumin utilization was obtained from pharmacy records and compared with outcome quality metrics.
  
  
  RESULTS
  In all, 1,401 patients were admitted over 13 months. Albumin use, mortality, ventilator days, patients receiving transfusions, and length of stay were compared for 961 patients before and 440 patients after guidelines were initiated. After restrictive guidelines were instituted, albumin utilization was reduced from a mean of 280 monthly doses to a mean of 101 monthly doses (p < 0.001). There was also a trend toward reduced ventilator days. Mortality, length of stay, and transfusion requirements demonstrated no significant change. Based on an average wholesale price and an average monthly reduction of 180 albumin doses, the cardiac surgery intensive care unit demonstrated more than $45,000 of wholesale savings per month after restrictions were implemented.
  
  
  CONCLUSIONS
  Albumin restriction in the cardiac surgery intensive care unit was feasible and safe. Significant reductions in utilization and cost with no changes in morbidity or mortality were demonstrated. These findings may provide a strategy for reducing cost while maintaining quality of care.
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: jrabin1@umm.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rabin
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Timothy
authors.initials: T
authors.lastname: Meyenburg
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Ashleigh V
authors.initials: AV
authors.lastname: Lowery
authors.affiliation: University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Rouse
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.affiliation: R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herr
mesh_terms: D000418:Albumins / Q000008:administration & dosage* / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods*; D016527:Drug Costs / Q000639:trends*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D034141:Hypoalbuminemia / Q000188:drug therapy* / Q000401:mortality; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000191:economics*; D008396:Maryland / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000418:Albumins