Skip to main content
2025 ASCRS Annual Scientific Meeting Main banner
Final Program


Visit ASCRS U
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Self-Assessment
Self-Assessment
Social
Social
Industry
Industry
Back

Session: Quick Shot: Quality and Cost

QS307 - Surgical Lessons Learned Due To IV Fluid Restrictions Following Hurricanes

Tuesday, May 13, 2025
8:43 AM – 8:46 AM PT
Location: Room 9, Upper Level

    Quick Shot Presenter(s)

  • Charlotte Stahlfeld

    Medical Student
    University of Pittsburgh
    Pittsburgh, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • KS

    Kurt Stahlfeld, MD, FACS

    Clinical Assistant Professor
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

    Disclosure information not submitted.

  • PA

    Peter D. Allen, MD

    Assistant Professor
    University of Pittsburgh Medical Center
    Allison Park, Pennsylvania, United States

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Charlotte Stahlfeld: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: In 2017 a hurricane in Puerto Rico disrupted the production of normal saline, resulting in mitigation guidelines that restricted fluids to surgical patients across the United States. This study evaluated the incidence of acute kidney injury (AKI) in post-operative patients who underwent major abdominal and colorectal surgery following our institutional implementation of fluid conservation protocols. Lessons learned from this cohort may help mitigate restrictive strategies that may be enacted due to the recent catastrophic events in North Carolina.

Methods/Interventions: Patients who underwent major abdominal or colorectal surgery during four months under our restrictive policy were compared to patients who underwent similar surgeries twelve months before implementation of the protocols. Patient demographics, type of surgery, baseline creatinine, and post-operative creatinine for seven days were collected. The primary endpoint was the incidence of AKI as defined by the Kidney Disease Outcomes Quality Initiative. The secondary endpoint was 30-day mortality.

Results/Outcomes: One hundred forty-three patients were identified in the pre- and post-hurricane (fluid-restrictive) major abdominal surgery group. Mean age, sex, and type of surgery were comparable in both arms. Patients in the fluid restrictive group had higher rates of AKI (28% v 16.8%, p = 0.023). Mortality was equivalent (4.9% v 2.8%, p = 0.356). For patients who only underwent colorectal surgery, fifty-three patients were identified in the pre-hurricane group and fifty-six patients were identified in the post-hurricane (fluid-restrictive) group. Patients in the fluid-restrictive group had higher rates of AKI (41.1% v 23.1%, p = 0.0459). Patients with a baseline creatinine of less than 2.0 also had higher rates of AKI (35.4% v 16.7%, p = 0.0448).

Conclusion/Discussion: For patients undergoing major abdominal and colorectal surgery at our institution, the prior fluid restrictive protocols enacted in response to a shortage of normal saline resulted in significant increase in the rate of AKI. This was especially true for patients with preexisting renal insufficiency. A slightly higher mortality did not reach statistical significance. Perioperative fluid resuscitation should not be compromised in these patients.