Cost Analysis of Different Volume Replacement Strategies in Anesthesia

Objective: Varying regimens of volume replacement are available. In today’s climate of cost consciousness and cost contain-ment it appears to be of interest to assess effective costs associated with the different fluid therapies. Design: Prospective, randomized study. Setting: Single-institutional, clinical investigation in an urban, university-affiliated hospital. Patients and Methods: 150 patients undergoing major abdominal surgery were divided into three groups. Perioperatively and until the first postoperative day, patient group 1 (n = 50) received 6% low-molecular weight hydroxyethyl starch (HES) (mean molecular weight (MW) 70 kDa, degree of substitution (DS) 0.5; HES 70/0.5), patient group 2 (n = 50) 6% medium-molecular weight HES (MW 200 kDa, DS 0.5; HES 200/0.5), and patient group 3 (n = 50) 3% modified fluid gelatin (MW 35 kDa) to keep mean arterial blood pressure (MAP) >70 mm Hg and central venous pressure (CVP) between 10 and 14 mm Hg. Results: The patients did not differ with regard to biometrics, type of surgery, and postoperative care. Hemodynamics (MAP, CVP), degree of hemodilution (hemoglobin), kidney (creatinine plasma level), liver (cholinesterase), and pulmonary function (paO2/FIO2) were without significant differences within the study. No differences were seen concerning blood loss, use of packed red blood cells (PRBC) and fresh frozen plasma (FFP). Significantly more gelatin (2,590 ± 500 ml) than HES 70/0.5 (2,130 ± 460 ml) and HES 200/0.5 (1,680 ± 430 ml) was given during the study period. Entire costs for volume replacement (in EUR and in USD) were significantly highest in the HES 70/0.5 group (118.25 EUR/patient, 134.45 USD/patient), whereas costs in the HES 200/0.5 (99.66 EUR/patient, 113.35 USD/patient) and the gelatin group (98.57 EUR/patient, 112.06 USD/patient) did not differ. Conclusions: Maintaining quality of patients’ care and simultaneously lowering costs represents a challenge. The type of fluid used for volume replacement continues to be debated. From the economic point of view, the use of gelatin offers no advantage compared to the use of HES 200/0.5. Only using HES 70/0.5 for volume therapy may result in some increases in costs.