title: Intra-operative hydroxyethyl starch is not associated with post-craniotomy hemorrhage.
abstract: BACKGROUND
  Intraoperative intravascular volume expansion with hydroxyethyl starch-based colloids is thought to be associated with an increased risk of post-craniotomy hemorrhage. Evidence for this association is limited. Associations between resuscitation with hydroxyethyl starch and risk of repeat craniotomy for hematoma evacuation were examined.
  
  
  METHODS
  Using a retrospective cohort of neurosurgical patients at Duke University Medical Center between March 2005 and March 2012, patient characteristics were compared between those who developed post-craniotomy hemorrhage and those who did not.
  
  
  RESULTS
  A total of 4,109 craniotomy procedures were analyzed with 61 patients having repeat craniotomy for post-operative hemorrhage (1.5%). The rate of reoperation in the group receiving 6% High Molecular Weight Hydroxyethyl Starch (Hextend(®)) was 2.6 vs. 1.3% for patients that did not receive hetastarch (P = 0.13). The reoperation rate for those receiving 6% hydroxyethyl Starch 130/0.4 (Voluven(®)) was 1.4 vs. 1.6% in patients not receiving Voluven (P = 0.85).
  
  
  CONCLUSIONS
  In this retrospective cohort, intra-operative hydroxyethyl starch was not associated with an increased risk of post-craniotomy hemorrhage.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Feix
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA.
authors.forename: C Andrew
authors.initials: CA
authors.lastname: Peery
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA ; Department of Anesthesiology, Stony Brook University, Stony Brook, NY USA.
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA ; Department of Neurosurgery, Duke University Medical Center, Durham, NC USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Warner
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA ; Department of Neurology, Duke University Medical Center, Durham, NC USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: James
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Zomorodi
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC USA ; Departments of Anesthesiology, Neurology, & Neurosurgery, University of Texas Southwestern, 5323 Harry Hines Blvd., Dallas, TX 75390-9068 USA.
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
keywords: Colloid; Craniotomy; Hemorrhage; Hydroxyethyl starch; Neuroanesthesia; Neurosurgery