title: Use of perioperative hydroxyethyl starch 6% and albumin 5% in elective joint arthroplasty and association with adverse outcomes: a retrospective population based analysis.
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.
  
  
  METHODS
  Retrospective cohort study of population based data between 2006 and 2013.
  
  
  METHODS
  Data from 510 different hospitals across the United States participating in the Premier Perspective database.
  
  
  METHODS
  1,051,441 patients undergoing elective total hip and knee arthroplasties.
  
  
  METHODS
  Perioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5%, or neither.
  
  
  METHODS
  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.
authors: Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, 5020 Salzburg, Austria.
authors: Mathias
authors: M
authors: Opperer
authors: Institute for Healthcare Delivery Science, Department of Population Health Science and Policy; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors: Jashvant
authors: J
authors: Poeran
authors: Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York.
authors: Rehana
authors: R
authors: Rasul
authors: Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York.
authors: Madhu
authors: M
authors: Mazumdar
authors: Weill Cornell Medical College, Department of Healthcare Policy and Research, New York; Department of Anesthesiology, Hospital for Special Surgery, New York; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg memtsoudiss@hss.edu.
authors: Stavros G
authors: SG
authors: Memtsoudis
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000368:Aged; D000418:Albumins / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods; D010952:Plasma Substitutes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes