Fluid Bundle Associated With Less Crystalloid Use and No More AKI

A hospital-wide fluid conservation bundle implemented during the 2024 national intravenous fluid shortage was associated with a 75.2% adjusted reduction in intraoperative crystalloid administration, without significant differences in intraoperative hypotension or postoperative acute kidney injury, according to a retrospective cohort study published in JAMA Network Open.

Investigators examined 38,976 patients in a Bronx, New York, hospital network from September 2 through December 31, 2024. The network comprised 9 hospitals of different acuity levels. The comparison included 12,026 patients before and 26,950 during bundle implementation; the full 12-step intervention was implemented October 9.

Median crystalloid volume per procedure fell from 450 mL to 150 mL; the adjusted exponentiated beta coefficient was 0.25 (95% CI, 0.24-0.26; P < .001). The intervention period was also associated with lower intraoperative urine output (adjusted exponentiated beta coefficient, 0.91; 95% CI, 0.85-0.96) and less intraoperative urinary catheter use (adjusted relative risk [ARR], 0.87; 95% CI, 0.83-0.92). Thirty-day readmissions were less frequent (ARR, 0.82; 95% CI, 0.75-0.89).

Weekly crystalloid costs rose 1,108% during the shortage, adding $749,541 over 12 weeks. Against estimated spending under preintervention use patterns, the bundle period was associated with an estimated $359,844 reduction (95% CI, $315,996-$403,692) in intraoperative crystalloid expenditure from October 9 through December 31. Total care costs did not differ significantly.

The authors cautioned that the single-network design limits generalizability and that readmissions were not categorized by diagnosis or preventability, leaving the reason for the association uncertain. They concluded that marked fluid conservation did not coincide with poorer patient-centered outcomes and noted that adequately powered randomized trials are still needed to define optimal intraoperative fluid volumes.

Source: Hopstein N, Borngaesser F, Droege L, et al. Standard intraoperative fluid practices during the 2024 intravenous fluid shortage. JAMA Netw Open. 2026;9(9):e2634064. doi:10.1001/jamanetworkopen.2026.34064