Intraoperative Adverse Events, Waste, and Costs Before and After Implementation of Intravenous Fluid Conservation During a National Shortage

BACKGROUND: Both medication shortages and hospital waste are important challenges in contemporary medicine. These challenges must be balanced to favor patient safety, which remains a fundamental goal of anesthesiology. METHODS: This retrospective study, based on material delivery and provider-reported major adverse intraoperative cardiovascular events, evaluates the impact of a fluid conservation strategy in the operating room, implemented on October 10, 2024, after the 2024 nationwide IV fluid shortage caused by Hurricane Milton. RESULTS: A total of 46,893 patients were cared for in the included operating rooms from October 2023 to January, 2025. The fluid conservation strategy successfully decreased weekly delivery requirements for fluids (median [IQR]: 1936 [1668-2055] vs 862 [740-1155] mL per case, P < .01; mean difference -1050 mL; 95% CI -665 to -1435 mL). This decrease was paralleled with a decrease in weekly costs for both fluids and fluid tubing (19,618 [13,991-21,930] vs 12,578 [9391-13,424] $, P < .01; mean difference -6784; 95% CI -1737 to -11,831 $) as well as weight of weekly plastic waste created 221.2 [205.6-246.5] vs 138.6 [105.7-155.2] kg, P < .01; mean difference -77 kg; 95% CI -25.7 to -128.8 kg). The incidence of major adverse events and case cancelations did not change after the implementation of the fluid reduction strategy. CONCLUSION: Our mitigation strategy decreased fluid usage per case, related costs, and plastic waste generated from fluids and infusion tubing. Further research focused on patient outcomes is needed before implementing such a strategy into standard care practice.