Albumin Use After Cardiac Surgery

OBJECTIVES: To investigate the effect of albumin exposure in ICU after cardiac surgery on hospital mortality, complications, and costs. DESIGN: A retrospective, single-center cohort study with economic evaluation. SETTING: Cardiothoracic ICU in Australia. PATIENTS: Adult patients admitted to the ICU after cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Comparison of outcomes and costs in ICU after cardiac surgery based on 4% human albumin exposure. During the study period, 3,656 patients underwent cardiac surgery. After exclusions, 2,594 patients were suitable for analysis. One-thousand two-hundred sixty-four (48.7%) were exposed to albumin and 19 (1.4%) of those died. The adjusted hospital mortality of albumin exposure compared with no albumin was not significant (odds ratio, 1.24; 95% CI, 0.56–2.79; p = 0.6). More patients exposed to albumin returned to the operating theater for bleeding and/or tamponade (6.1% vs 2.1%; odds ratio, 2.84; 95% CI, 1.81–4.45; p < 0.01) and received packed red cell transfusions (p < 0.001). ICU and hospital lengths of stay were prolonged in those exposed to albumin (mean difference, 18 hr; 95% CI, 10.3–25.6; p < 0.001 and 87.5 hr; 95% CI, 40.5–134.6; p < 0.001). Costs (U.S. dollar) were higher in patients exposed to albumin, compared with those with no albumin exposure (mean difference in ICU costs, $2,728; 95% CI, $1,566–3,890 and mean difference in hospital costs, $5,427; 95% CI, $3,294–7,560). CONCLUSIONS: There is no increased mortality in patients who are exposed to albumin after cardiac surgery. The patients exposed to albumin had higher illness severity, suffered more complications, and incurred higher healthcare costs. A randomized controlled trial is required to determine whether albumin use is effective and safe in this setting.