Perioperative Albumin Among Adults Undergoing Thoracic Surgery in the United States: Utilization, Associations With Clinical Outcomes, and Contribution to Hospital Costs.

Objectives: To estimate the use of albumin among adults undergoing thoracic surgery in the United States, compare baseline characteristics, clinical and cost outcomes of recipients versus nonrecipients, and determine albumin's contribution to total hospital costs.
Design: Retrospective cohort study.
Setting: Nationwide sample of US hospitals.
Participants: Adults undergoing open and minimally invasive thoracic surgery between 2011 and 2017.
Interventions: Albumin on the day of surgery (identified using itemized hospital billing logs).
Measurements and Main Results: Albumin was used in 170 of 342 US hospitals, among 13% and 7% of 14,672 and 22,532 patients who, respectively, underwent open and minimally invasive thoracic surgery (median volume 500 mL). Baseline comorbidities and organ-supportive treatments were several-fold more prevalent among recipients (particularly vasopressors, mechanical ventilation, and red cell transfusions). In standardized mortality ratio propensity score weighted analysis, albumin use was not associated with in-hospital mortality (adjusted relative risk 1.17 [0.72, 1.92] and 1.51 [0.97, 2.34], with open and minimally invasive procedures), but was associated with morbidity and higher costs, more so with minimally invasive procedures than with open surgery. Total costs among recipients were higher by $4,744 ($3,591, $5,897) and $5,088 ($4,075, $6,100) for open and minimally invasive procedures, respectively. Albumin accounted for 2.6% of this difference (median $124 [$83-$189] per patient).
Conclusions: Albumin use varies widely across hospitals, and 9% of patients receive it (median 500 mL). Use was not associated with in-hospital mortality and was associated with more morbidity and cost. The cost of albumin accounted for a trivial portion of hospital costs. Clinical trials must examine the effects of albumin on complications and costs after thoracic surgery.
Competing Interests: Declaration of competing interest K.R. is a consultant for Grifols North America, a major supplier of Human-Derived Albumin. This study was conducted via a Cooperative Research and Development Agreement between Grifols and the nonprofit corporation affiliated with the Durham VA Medical Center (the Institute for Medical Research, Durham, NC). All other authors have no relevant disclosures to report.
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