Use of perioperative hydroxyethyl starch 6% and albumin 5% in elective joint arthroplasty and association with adverse outcomes: a retrospective population based analysis.

Objective: To determine whether the perioperative use of hydroxyethyl starch 6% and albumin 5% in elective joint arthroplasties are associated with an increased risk for perioperative complications.
Design: Retrospective cohort study of population based data between 2006 and 2013.
Setting: Data from 510 different hospitals across the United States participating in the Premier Perspective database.
Participants: 1,051,441 patients undergoing elective total hip and knee arthroplasties.
Exposures: Perioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5%, or neither.
Main Outcome Measures: Acute renal failure and thromboembolic, cardiac, and pulmonary complications.
Results: Compared with patients who received neither colloid, perioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5% was associated with an increased risk of acute renal failure (odds ratios 1.23 (95% confidence interval 1.13 to 1.34) and 1.56 (1.36 to 1.78), respectively) and most other complications. A recent decrease in hydroxyethyl starch 6% use was noted, whereas that of albumin 5% increased.
Conclusions: Similar to studies in critically ill patients, we showed that use of hydroxyethyl starch 6% was associated with an increased risk of acute renal failure and other complications in the elective perioperative orthopedic setting. This increased risk also applied to albumin 5%. These findings raise questions regarding the widespread use of these colloids in elective joint arthroplasty procedures.
(© Opperer et al 2015.)