Perioperative Hypertonic Saline May Reduce Postoperative Infections and Lower Mortality Rates

Background: To determine the effects of hypertonic saline (HS) as fluid resuscitation during or after major spinal surgery. We hypothesized that the administration of HS perioperatively would decrease morbidity and mortality rates. Methods: A two-year retrospective, pair-matched, case-control study of adult patients (57 pairs matched 1: 1) admitted to the intensive care unit (ICU) after major spinal procedures in a tertiary-and quaternary-care university medical center. Patients were matched for year of operation, operation site and magnitude, age, and sex. Each pair consisted of a patient who received HS either intraoperatively or postoperatively (Study patient) and a Control patient (isotonic fluids). Results: No significant differences were seen in the underlying diseases. Neither the percentage of patients extubated in the operating room (OR) (Study, 44%; Control, 51%) nor the total time of intubation differed in the two groups. Patients receiving HS were in the operating room slightly longer. Length of stay (LOS) in the ICU was a median of 22 h in both groups. Hospital LOS was 7.7 +/- 6.1 days in the HS group and 7.3 +/- 3.5 days in the Control group (p = 0.98). Three infections occurred in the HS group and 11 in the Control group (p = 0.04). The total number of patients with one or more other complications was 11 in the HS group and 16 in the Control group (p = 0.19). Death occurred in two patients in the HS group and seven patients in the Control group (p = 0.08). Conclusions: Perioperative use of HS in major spinal surgery was associated with fewer postoperative infections, as well as trends toward fewer complications and a lower mortality rate. Further studies with strict protocols are warranted.