Albumin utilization in cardiac surgery after transition to hydroxyethyl starch 130/0.4.
OBJECTIVE
Evaluate the impact of replacing hydroxyethyl starch (HES) 670/0.75 with lower molecular weight HES 130/0.4 on albumin utilization in cardiac surgery, as well as any impact on renal function and bleeding.


METHODS
A pre- and postimplementation, retrospective analysis.


METHODS
Community, not-for-profit, tertiary medical center.


METHODS
One hundred forty-six patients undergoing nonemergent cardiac bypass graft and cardiac valve surgeries after exclusion for documented anemia, malignancy, coagulation disorder, end-stage renal disease, or personal objection to receiving blood products.


METHODS
HES 130/0.4 utilization instead of HES 670/0.75 for volume expansion.


RESULTS
Patients were less likely to be administered albumin intraoperatively (odds ratio [OR] 0.16, confidence interval [CI] 0.08-0.35, P < .001). When albumin was utilized, intraoperative amounts were similar (mean ± standard deviation [SD]: 36.1 ± 17.1 g vs 43.8 ± 15.5 g, P = .16). Patients were more likely to receive an intraoperative HES product after the formulary change (OR 11.1, CI 4.4-27.6, P < .001) as well as larger volumes (mean ± SD: 743 ± 544 mL vs 500 ± 0 mL, P = .01). No differences were detected in mean baseline-to-discharge changes in serum creatinine or in postoperative urine output, nor were there differences in clinically significant bleeding.


CONCLUSIONS
Change to a lower molecular weight HES decreased intraoperative albumin utilization and increased HES utilization with no detected difference in renal function or bleeding complications.
Pharmacy Practice, University of New England College of Pharmacy, Portland, ME 04103, USA. dromerill@une.edu
David B
DB
Romerill
Alexander Y
AY
Toyoda
Brandon E
BE
Brodeur
Daniel
D
Moellentin
D000368:Aged; D000418:Albumins / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes