• Mathias Opperer, Jashvant Poeran, Rehana Rasul, Madhu Mazumdar, and Stavros G Memtsoudis.
• 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.
• BMJ. 2015 Jan 1;350:h1567.

ObjectiveTo 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.DesignRetrospective cohort study of population based data between 2006 and 2013.SettingData from 510 different hospitals across the United States participating in the Premier Perspective database.Participants1,051,441 patients undergoing elective total hip and knee arthroplasties.ExposuresPerioperative fluid resuscitation with hydroxyethyl starch 6% or albumin 5%, or neither.Main Outcome MeasuresAcute renal failure and thromboembolic, cardiac, and pulmonary complications.ResultsCompared 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.ConclusionsSimilar 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.© Opperer et al 2015.

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