Standard Intraoperative Fluid Practices During the 2024 Intravenous Fluid Shortage

Importance A nationwide intravenous fluid shortage in 2024 prompted hospitals to substantially reduce intraoperative crystalloid administration, creating a natural experiment to examine standard intraoperative fluid practices. The clinical consequences of such abrupt reductions in fluid use remain unclear. Objective To evaluate the associations among a marked reduction in intraoperative crystalloid administration, perioperative outcomes, and costs of care. Design, Setting, and Participants This retrospective cohort study was conducted from September 2 to December 31, 2024, across a hospital network in the Bronx, New York, comprising adults undergoing surgery at 9 hospitals of different acuity levels. Exposure The exposure was the implementation of a hospital-wide intervention aimed at reducing intraoperative intravenous crystalloid administration. Main Outcomes and Measures Primary outcomes included change in intraoperative crystalloid administration. Additional outcomes included intraoperative hypotension, urine output, urinary catheter utilization, hospital readmissions, postoperative acute kidney injury, length of stay, and costs of care. Results A total of 38 976 patients (mean [SD], age 55.7 [19.8] years; 21 944 [56.3%] female), including 12 026 (30.9%) before and 26 950 (69.1%) during implementation of a fluid reduction bundle, were included in the study. The implementation of the fluid reduction bundle was associated with a 75.2% lower intraoperative crystalloid administration (adjusted exponentiated β coefficient [ e β ], 0.25; 95% CI, 0.24-0.26; P < .001). The intervention was associated with lower urine output (adjusted e β , 0.91; 95% CI, 0.85-0.96; P = .002), reduced urinary catheter utilization (adjusted relative risk [ARR], 0.87; 95% CI, 0.83-0.92; P < .001), and fewer hospital readmissions (ARR, 0.82; 95% CI, 0.75-0.89; P < .001). There were no meaningful differences in intraoperative hypotension (adjusted e β , 1.01; 95% CI, 1.00-1.02; P = .07), postoperative acute kidney injury (ARR, 0.97; 95% CI, 0.86-1.09; P = .58), or costs of care (adjusted e β , 1.00; 95% CI, 0.98-1.01; P = .46). Conclusions and Relevance In this cohort study’s natural experiment, grossly reduced intraoperative crystalloid fluid administration was associated with lower urine output, reduced urinary catheter use, and fewer hospital readmissions, without worse patient-centered outcomes. These results challenge standard intraoperative fluid practices.