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Multicenter Study
. 2015 Mar 27:350:h1567.
doi: 10.1136/bmj.h1567.

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

Mathias Opperer  1 , Jashvant Poeran  2 , Rehana Rasul  3 , Madhu Mazumdar  3 , Stavros G Memtsoudis  4
Affiliations
Multicenter Study

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

Mathias Opperer et al. BMJ. .

Abstract

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Comment in

References

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