Saline vs. Lactated Ringer's in Surgical Patients

In studies published in 2018, the incidence of adverse kidney events was slightly higher with normal saline than with balanced crystalloid (usually lactated Ringer's solution) in acutely hospitalized patients who required fluid resuscitation (NEJM JW Gen Med Apr 15 2018 and N Engl J Med 2018; 378:819). Now, Cleveland Clinic researchers have compared these solutions in surgery patients: Nearly 9000 adults who underwent colorectal or major orthopedic surgery received saline or lactated Ringer's intraoperatively. The design was an alternating cohort controlled trial in which all patients received one or the other solution, in alternating 2-week blocks.

Incidence of a composite endpoint (in-hospital mortality or major postoperative renal, respir…