title: Colloids in Cardiac Surgery-Friend or Foe?
abstract: OBJECTIVE
  The right choice of fluid replacement still is a matter of debate. Recently, two large-scale studies on the use of hydroxyethyl starches (HES) in the intensive care setting have been published, which have caused a huge shift in the daily practice of volume therapy. These results have been applied to patients outside intensive care. The aim of this study was to evaluate the impact this change has had on the outcomes in a large population of cardiac surgery patients, with a focus on the type of colloid infusion.
  
  
  METHODS
  A prospective, registered, observational study, using propensity score matching.
  
  
  METHODS
  Cohort study from 3 university hospitals using a common registry.
  
  
  METHODS
  The study comprised 17,742 patients who were referred for cardiac surgery from 2007 to 2014.
  
  
  METHODS
  Patients were divided in groups according to perioperative fluid replacement with either crystalloids or colloids. The colloid group was further divided into HES or human albumin (HA). Analyses were based on the following 3 subsections: HES versus crystalloids, HA versus crystalloids, and HES versus HA, with use of propensity score matching or direct matching of cases. Primary outcome parameters were 30-day and 6-month mortality, new postoperative renal replacement therapy, and new cardiac ischemic events.
  
  
  RESULTS
  The groups were fully comparable in individual analyses. The use of HES had no impact on new dialysis and 30-day mortality. A Cox proportional regression analysis showed that HES had no impact on 6-month mortality and new postoperative ischemic events. When comparing HA with crystalloid use, a significantly increased risk in crude analysis was demonstrated on all outcome parameters; and when comparing HA with HES, a significantly higher risk was observed in HA patients in mortality parameters and new postoperative, but after adjustment, only the risk of new postoperative dialysis persisted.
  
  
  CONCLUSIONS
  This study underlined the difficulties in establishing hardcore outcome data, even in large cohort studies. The findings seemed to diminish the magnitude of risk when using HES in cardiac surgery patients and seriously questioned the choice of HA when a plasma expander is needed.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Pia Katarina
authors.initials: PK
authors.lastname: Ryhammer
authors.affiliation: Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mariann
authors.initials: M
authors.lastname: Tang
authors.affiliation: Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
authors.forename: Joachim
authors.initials: J
authors.lastname: Hoffmann-Petersen
authors.affiliation: Department of Thoracic Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Dovile
authors.initials: D
authors.lastname: Leonaviciute
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Greisen
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Storebjerg Gissel
authors.affiliation: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark. Electronic address: cjj@dadlnet.dk.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Jakobsen
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D015331:Cohort Studies; D003102:Colloids; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005500:Follow-Up Studies; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes
keywords: cardiac recovery; cardiac surgery; dialysis; human albumin; hydroxyethyl starch; ischemic heart disease