• Myung-Soo Jang, Jin-Hee Han, SangHo Lee, and Sung-Eun Kim.
• Department of Anesthesiology and Pain Medicine, Kyung Hee Medical Center.
• Clin Spine Surg. 2019 Mar 1; 32 (2): E65-E70.

Study DesignRetrospective analysis.ObjectiveThe objective of this study was to investigate the effects of intraoperative balanced 6% hydroxyethyl starch (HES) 130/0.4 on postoperative blood loss and the coagulation profile.Summary Of Background DataThe safety of colloid versus crystalloid transfusion for bleeding and coagulation during major spine surgery remains controversial and only a few studies exist. Thus, we compared the effects of balanced 6% HES 130/0.4 and crystalloid on postoperative bleeding and coagulation.MethodsPatients undergoing spine surgery between February 1, 2015 and February 28, 2017 were divided into 2 groups: patients receiving intraoperative balanced 6% HES 130/0.4 and patients receiving crystalloid. We compared the postoperative bleeding volume with changes in the coagulation profile and length of hospital stay between these 2 groups. Propensity score (PS)-matching and multivariate stepwise linear regression were performed.ResultsA total of 169 patients who met the inclusion criteria were analyzed. The quantity of total colloid per patient was 10-15 mL/kg. A significant difference was observed in the total intraoperative transfused crystalloid volume between the 2 groups (colloid group, 1.394.6±1.414.0 mL; crystalloid group, 2.027.3±1.114.1 mL; P<0.001). Postoperative blood loss and coagulation profile changes were not significantly different in the 60 PS-matched paired patients. Furthermore, no differences in either postoperative transfusion requirement or length of hospital stay were observed between the groups. Multivariate stepwise linear regression revealed that operation time (β=0.549; P<0.001) and intraoperative transfusion of packed red blood cells (β=0.466; P=0.003) or fresh frozen plasma (β=-0.263; P=0.041) were independently associated with postoperative blood loss. However, intraoperative colloid administration was not a predictive factor.ConclusionsIntraoperative infusion of balanced 6% HES 130/0.4 in patients undergoing spine surgery presented clinically insignificant changes in postoperative blood loss and coagulation compared to crystalloid.Level Of EvidenceLevel III.

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