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IV Fluid Conservation And Its Impact On Plastic Surgery Services: Safe Or Not?
Alexandra Junn, MD1, Eric L. Wan, MPH, MBA
2, Paul Martinez, MD
1, Sophia Arbuiso, BS
3, Jasmine Chaij, BS
4, Kenneth L. Fan, MD
1, David H. Song, MD, MBA
1, Christopher E. Attinger, MD
1, Richard C. Youn, MD
1, Karen K. Evans, MD
1.
1Department of Plastic Surgery, Medstar Georgetown University Medical Center, Washington, DC, DC, USA, 2Georgetown University School of Medicine, Washington, DC, DC, USA, 3New York Medical College, Valhalla, NY, USA, 4University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, USA.
PURPOSE: Hospitals began conserving IV fluids after Hurricane Helene interrupted IV fluid production. Patients who are made N.p.o. prior to procedures may be predisposed to acute kidney injury (AKI). We analyzed the short-term impact of IV fluid restriction on AKIs in a large plastic surgery limb service.
METHODS: We sampled 48 operations between 9/16/2024 to 9/20/2024 (before the hurricane) and 49 procedures between 10/14/2024 to 10/19/2024 (after the hurricane and during IV fluid conservation). We reviewed labs to identify whether AKI developed on post-op day 1, 2, 3, or 7, and we reviewed service notes to understand how these AKIs were managed. We compared AKI rates and management before and after IV fluid conservation.
RESULTS: AKIs developed in 8/48 (17%) patients before IV fluid conservation and in 7/49 (14%) patients after conservation. The majority (14/15) of AKIs developed at or before POD3 and resolved by POD7. We observed no statistically significant differences between average creatinine levels at any PODs, although the average increase in creatinine at POD1 in patients who developed AKI before conservation was 1.04, compared to 2.49 after. In addition, more patients after IV fluid conservation were uptriaged to ICU with AKIs (3/7) vs no patients before conservation.
CONCLUSION: IV fluid conservation may be conducted safely from an AKI perspective. However, we caution that fluid restriction may cause more kidney damage to patients at risk for other concomitant nephrologic conditions.
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