Ave cost of a crystalloid-based volume replacement regimen lower than of a colloid-based volume replacement strategy?

Objective: Adequate volume therapy is a cornerstone for treating patients undergoing major surgery. The age-old crystalloid/colloid debate is still unsolved. The current push to reduce cost may also include considerations about the lowest cost for volume replacement therapy. Material and Methods: The study was designed as a prospective, randomized, single-institutional, clinical investigation in an urban, university-affiliate hospital. 100 patients scheduled for major abdominal surgery were randomized into 4 groups: either crystalloids (Ringer's lactate (RL), n = 25), 6% hydroxyethyl starch (mean molecular weight (MW) 200 kDa, degree of substitution (DS) 0.5; HES 200, n = 25), a new 6% hydroxyethyl starch (MW 130 kDa, DS 0.4; HES 130, n = 25), or 4% modified fluid gelatin (MW 35 kDa, n = 25) were given until the Ist postoperative day (POD) to keep central venous pressure between 8 and 12 mm Hg. Cost for either volume replacement regimen were calculated, including acquisition cost of the substance as well as those of blood products and disposables used. Results: Even when infusing high doses of crystalloids (until Ist POD: 11,550 +/- 850 ml), 10 patients showed orthostatic dysregulation. Gelatin-treated patients needed the largest amount of volume (3,350 +/- 360 ml) of the colloid groups (HES 200: 2,350 +/- 240 ml; HES 130: 2,590 +/- 310 ml). Cost of blood products exceeded cost of non-blood fluids markedly (RL group: EUR 68.60 per patient), but did not differ between the four groups. Difference of total cost (fluids, blood products, disposables) between the crystalloid and the cheapest colloid group (HES 200) was EUR 12.60 per patient. Conclusion: By the choice of a particular volume replacement strategy, no big cost savings can be achieved in patients undergoing major abdominal surgery. Other aspects than only acquisition cost should be taken into consideration when deciding for a specific volume replacement strategy.