• Alexandre Joosten, Amélie Delaporte, Julien Mortier, Brigitte Ickx, Luc Van Obbergh, Jean-Louis Vincent, Maxime Cannesson, Joseph Rinehart, and Philippe Van der Linden.
• From the Departments of Anesthesiology (A.J., A.D., J.M., B.I., L.V.O.) Intensive Care (J.L.V.) CUB Erasme and the Department of Anesthesiology, Brugmann Hospital (P.V.d.L.), Université Libre de Bruxelles, Bruxelles, Belgium the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (A.J.) the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (M.C.) the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange County, California (J.R.).
• Anesthesiology. 2019 Feb 1; 130 (2): 227-236.

BackgroundThe authors recently demonstrated that administration of balanced hydroxyethyl starch solution as part of intraoperative goal-directed fluid therapy was associated with better short-term outcomes than administration of a balanced crystalloid solution in patients having major open abdominal surgery. In the present study, a 1-yr follow-up of renal and disability outcomes in these patients was performed.MethodsAll patients enrolled in the earlier study were followed up 1 yr after surgery for renal function and disability using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The main outcome measure was the estimated glomerular filtration rate. Other outcomes were serum creatinine, urea, pruritus, and WHODAS score. Groups were compared on a complete-case analysis basis, and modern imputation methods were then used in mixed-model regressions to assess the stability of the findings taking into account the missing data.ResultsOf the 160 patients enrolled in the original study, follow-up data were obtained for renal function in 129 and for WHODAS score in 114. There were no statistically significant differences in estimated glomerular filtration rate at 1 yr (ml min 1.73 m): 80 [65 to 92] for crystalloids versus 74 [64 to 94] for colloids; 95% CI [-10 to 7], P = 0.624. However, the WHODAS score (%) was statistically significantly lower in the colloid than in the crystalloid group (2.7 [0 to 12] vs. 7.6 [1.3 to 18]; P = 0.015), and disability-free survival was higher (79% vs. 60%; 95% CI [2 to 39]; P = 0.024).ConclusionsIn patients undergoing major open abdominal surgery, there was no evidence of a statistically significant difference in long-term renal function between a balanced hydroxyethyl starch and a balanced crystalloid solution used as part of intraoperative goal-directed fluid therapy, although there was only limited power to rule out a clinically significant difference. However, disability-free survival was significantly higher in the colloid than in the crystalloid group.

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