Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte

Ann Surg. 2012 May;255(5):821-9. doi: 10.1097/SLA.0b013e31825074f5.


Objective: To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery.

Background: 0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume losses after major surgery.

Methods: An observational study using the Premier Perspective Comparative Database was performed to evaluate adult patients undergoing major open abdominal surgery who received either 0.9% saline (30,994 patients) or a balanced crystalloid solution (926 patients) on the day of surgery. The primary outcome was major morbidity and secondary outcomes included minor complications and acidosis-related interventions. Outcomes were evaluated using multivariable logistic regression and propensity scoring models.

Results: For the entire cohort, the in-hospital mortality was 5.6% in the saline group and 2.9% in the balanced group (P < 0.001). One or more major complications occurred in 33.7% of the saline group and 23% of the balanced group (P < 0.001). In the 3:1 propensity-matched sample, treatment with balanced fluid was associated with fewer complications (odds ratio 0.79; 95% confidence interval 0.66-0.97). Postoperative infection (P = 0.006), renal failure requiring dialysis (P < 0.001), blood transfusion (P < 0.001), electrolyte disturbance (P = 0.046), acidosis investigation (P < 0.001), and intervention (P = 0.02) were all more frequent in patients receiving 0.9% saline.

Conclusions: Among hospitals in the Premier Perspective Database, the use of a calcium-free balanced crystalloid for replacement of fluid losses on the day of major surgery was associated with less postoperative morbidity than 0.9% saline.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardioplegic Solutions / adverse effects*
  • Child
  • Comorbidity
  • Digestive System Surgical Procedures*
  • Emergency Medical Services
  • Gluconates / adverse effects
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Magnesium Chloride / adverse effects
  • Middle Aged
  • Multivariate Analysis
  • Potassium Chloride / adverse effects
  • Propensity Score
  • Retrospective Studies
  • Sodium Acetate / adverse effects
  • Sodium Chloride / adverse effects*
  • Water-Electrolyte Balance
  • Young Adult


  • Cardioplegic Solutions
  • Gluconates
  • Plasma-lyte 148
  • Magnesium Chloride
  • Sodium Chloride
  • Sodium Acetate
  • Potassium Chloride