K. Dammann1, M. Timmons1, C. Pierce2, E. Higdon2, M. Edelman1, A. Bernard1 1University Of Kentucky,Acute Care Surgery And Trauma, Department Of Surgery,Lexington, KY, USA 2University Of Kentucky,Pharmacy Services,Lexington, KY, USA
Introduction: Postoperative patients have increased susceptibility to alterations in electrolyte homeostasis. Although electrolytes are replaced in the critically ill, cultural norms in clinical practice today prompts the treatment of abnormal electrolytes in stable asymptomatic ward patients. Here we hypothesized that although there is no proven benefit in asymptomatic patients, electrolyte analysis and replacement is associated with significant cost.
Methods: The study was IRB-approved. Using the electronic medical records and pharmacy database at a University academic medical center for 2016, the frequency and cost of electrolyte analysis (BMP, ion-Ca, Mg, Phos) and replacement (KCl, Mg, oral/IV Ca, oral/IV Phos) was characterized in perioperative trauma and general surgery (GS) patients. Patients without an oral diet order, with creatinine >1.4, age <16 y, admitted to ICU or with length of stay >1wk were excluded. Nursing costs were calculated as a fraction of hourly wages per each lab order or electrolyte replacement.
Results: Over the 11-month study period, forty-five of 62 patients analyzed met our criteria. Fifty-two percent were male and 48% female with an average length of stay of 4 ± 1.8 days; mean age 54 ± 14 years; and creatinine 0.67 ± 0.26. Thirty-one GS and 14 trauma patients had 421 electrolyte analysis lab orders at a cost of $2850; BMP was most frequent of these with median of (2: 1-6) per stay, accounting for 33% of lab costs. GS and trauma subjects combined received 253 doses of electrolytes at a total pharmacy cost of $928; with KCl (47), Phos (20), Ca (18), and Mg (14) percent of pharmacy costs. Mg was most frequently replaced (84% GS vs 71% trauma); followed by KCl (71% of GS vs 29% trauma); then Phos (29% GS vs 17% trauma). Electrolyte replacement was 38% more frequent in GS vs trauma subjects. Nursing costs associated with electrolyte analysis/replacement amounted to $3040.
Conclusion: There is little evidence to support electrolyte analysis and replacement in stable asymptomatic ward patients, but its prevalence and cost ($6818) in this study was substantial in a small proportion of patients. BMP’s, pharmacy charges for potassium, and nursing staff costs accounted for the most significant portion of total cost. Electrolyte replacement by house staff occurred more frequently in GS patients when compared to trauma patients managed by surgical attending providers. Considering these data, further research should determine whether these practices are truly warranted.
