• David B Romerill, Alexander Y Toyoda, Brandon E Brodeur, and Daniel Moellentin.
• Pharmacy Practice, University of New England College of Pharmacy, Portland, ME 04103, USA. dromerill@une.edu
• J Pharm Pract. 2012 Dec 1;25(6):606-10.

ObjectiveEvaluate 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.DesignA pre- and postimplementation, retrospective analysis.SettingCommunity, not-for-profit, tertiary medical center.ParticipantsOne 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.InterventionHES 130/0.4 utilization instead of HES 670/0.75 for volume expansion.Measurements And Main ResultsPatients 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.ConclusionsChange to a lower molecular weight HES decreased intraoperative albumin utilization and increased HES utilization with no detected difference in renal function or bleeding complications.

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