{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:53:04Z","timestamp":1789487584927,"version":"build-2803163510"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n A nationwide intravenous fluid shortage in 2024 prompted hospitals to substantially reduce intraoperative crystalloid administration, creating a natural experiment to examine standard intraoperative fluid practices. The clinical consequences of such abrupt reductions in fluid use remain unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the associations among a marked reduction in intraoperative crystalloid administration, perioperative outcomes, and costs of care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was conducted from September 2 to December 31, 2024, across a hospital network in the Bronx, New York, comprising adults undergoing surgery at 9 hospitals of different acuity levels.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n The exposure was the implementation of a hospital-wide intervention aimed at reducing intraoperative intravenous crystalloid administration.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes included change in intraoperative crystalloid administration. Additional outcomes included intraoperative hypotension, urine output, urinary catheter utilization, hospital readmissions, postoperative acute kidney injury, length of stay, and costs of care.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 38\u202f976 patients (mean [SD], age 55.7 [19.8] years; 21\u202f944 [56.3%] female), including 12\u202f026 (30.9%) before and 26\u202f950 (69.1%) during implementation of a fluid reduction bundle, were included in the study. The implementation of the fluid reduction bundle was associated with a 75.2% lower intraoperative crystalloid administration (adjusted exponentiated \u03b2 coefficient [\n e<\/jats:italic>\n \u03b2<\/jats:sup>\n ], 0.25; 95% CI, 0.24-0.26;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The intervention was associated with lower urine output (adjusted\n e<\/jats:italic>\n \u03b2<\/jats:sup>\n , 0.91; 95% CI, 0.85-0.96;\n P<\/jats:italic>\n \u2009=\u2009.002), reduced urinary catheter utilization (adjusted relative risk [ARR], 0.87; 95% CI, 0.83-0.92;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and fewer hospital readmissions (ARR, 0.82; 95% CI, 0.75-0.89;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). There were no meaningful differences in intraoperative hypotension (adjusted\n e<\/jats:italic>\n \u03b2<\/jats:sup>\n , 1.01; 95% CI, 1.00-1.02;\n P<\/jats:italic>\n \u2009=\u2009.07), postoperative acute kidney injury (ARR, 0.97; 95% CI, 0.86-1.09;\n P<\/jats:italic>\n \u2009=\u2009.58), or costs of care (adjusted\n e<\/jats:italic>\n \u03b2<\/jats:sup>\n , 1.00; 95% CI, 0.98-1.01;\n P<\/jats:italic>\n \u2009=\u2009.46).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study\u2019s natural experiment, grossly reduced intraoperative crystalloid fluid administration was associated with lower urine output, reduced urinary catheter use, and fewer hospital readmissions, without worse patient-centered outcomes. These results challenge standard intraoperative fluid practices.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.34064","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:00:20Z","timestamp":1789484420000},"page":"e2634064","source":"Crossref","is-referenced-by-count":0,"title":["Standard Intraoperative Fluid Practices During the 2024 Intravenous Fluid Shortage"],"prefix":"10.1001","volume":"9","author":[{"given":"Noah","family":"Hopstein","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Borngaesser","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"University Clinic for Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Carl von Ossietzky Universit\u00e4t Oldenburg and Klinikum Oldenburg A\u00f6R, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Droege","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"University Clinic for Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Carl von Ossietzky Universit\u00e4t Oldenburg and Klinikum Oldenburg A\u00f6R, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafi","family":"Khandaker","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Kiyatkin","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Rinke","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center, Yonkers, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P.","family":"Semczuk","sequence":"additional","affiliation":[{"name":"Moses Campus & Faculty Practice Group, Montefiore Health System, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Medical Affairs, Montefiore Health System, Bronx, New 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York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibraheem M.","family":"Karaye","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomer","family":"Kotek","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adela M.","family":"Aguirre-Alarcon","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance","family":"Rippel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothee S.","family":"Straetz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Department of Anaesthesiology, University Children\u2019s Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele C.","family":"Siciliano","sequence":"additional","affiliation":[{"name":"Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Hallick","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiman M.","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Racine","sequence":"additional","affiliation":[{"name":"Montefiore Health System, Bronx, New York"},{"name":"Department of Paediatrics, Children\u2019s Hospital at Montefiore\/Einstein, Bronx, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Eikermann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York"},{"name":"Klinik f\u00fcr An\u00e4sthesiologie und Intensivmedizin, Universit\u00e4t Duisburg-Essen, Essen, 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Baxter provides update on North Cove, N.C., facility and Hurricane Helene relief plans for community. September 29, 2024. Accessed April 7, 2025. https:\/\/www.baxter.com\/baxter-newsroom\/baxter-provides-update-north-cove-nc-facility-and-hurricane-helene-relief-plans"},{"key":"zoi260924r9","unstructured":"American Hospital Association. Baxter provides updates on efforts to increase access to and supply of IV solutions. October 24, 2024. Accessed April 7, 2025. https:\/\/www.aha.org\/system\/files\/media\/file\/2024\/10\/baxter-provides-updates-on-efforts-to-increase-access-to-and-supply-of-iv-solutions-october-24-2024.pdf"},{"key":"zoi260924r10","unstructured":"American Society of Health-System Pharmacists. Small- and large-volume fluid shortages suggestions for management and conservation. November 25, 2024. 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