• Jose I Suarez, Renee H Martin, Samuel F Hohmann, Eusebia Calvillo, Eric M Bershad, Chethan P Venkatasubba Rao, Alexandros Georgiadis, Oliver Flower, David Zygun, and Simon Finfer.
• 1Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, TX. 2Divison of Biostatistics, Data Coordinating Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC. 3Comparative Data and Informatics Research, University HealthSystem Consortium, Chicago, IL. 4Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia. 5Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AL, Canada. 6The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.
• Crit. Care Med. 2017 Jan 1; 45 (1): e16-e22.

ObjectiveTo determine rates and predictors of albumin administration, and estimated costs in hospitalized adults in the United States.DesignCohort study of adult patients from the University HealthSystem Consortium database from 2009 to 2013.SettingOne hundred twenty academic medical centers and 299 affiliated hospitals.PatientsA total of 12,366,264 hospitalization records.InterventionsAnalysis of rates and predictors of albumin administration, and estimated costs.Measurements And Main ResultsOverall the proportion of admissions during which albumin was administered increased from 6.2% in 2009 to 7.5% in 2013; absolute difference 1.3% (95% CI, 1.30-1.40%; p < 0.0001). The increase was greater in surgical patients from 11.7% in 2009 to 15.1% in 2013; absolute difference 3.4% (95% CI, 3.26-3.46%; p < 0.0001). Albumin use varied geographically being lowest with no increase in hospitals in the North Eastern United States (4.9% in 2009 and 5.3% in 2013) and was more common in bigger (> 750 beds; 5.2% in 2009 and 7.3% in 2013) compared to smaller hospitals (< 250 beds; 4.4% in 2009 to 6.2% in 2013). Factors independently associated with albumin use were appropriate indication for albumin use (odds ratio, 65.220; 95% CI, 62.459-68.103); surgical admission (odds ratio, 7.942; 95% CI, 7.889-7.995); and high severity of illness (odds ratio, 8.933; 95% CI, 8.825-9.042). Total estimated albumin cost significantly increased from $325 million in 2009 to $468 million in 2013; (absolute increase of $233 million), p value less than 0.0001.ConclusionsThe proportion of hospitalized adults in the United States receiving albumin has increased, with marked, and currently unexplained, geographic variability and variability by hospital size.

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