Albumin Utilization in Cardiac Surgery After Transition to Hydroxyethyl Starch 130/0.4

Abstract

Objective: Evaluate 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. Design: A pre- and postimplementation, retrospective analysis. Setting: Community, not-for-profit, tertiary medical center. Participants: One 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. Intervention: HES 130/0.4 utilization instead of HES 670/0.75 for volume expansion. Measurements and Main Results: Patients 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. Conclusions: Change to a lower molecular weight HES decreased intraoperative albumin utilization and increased HES utilization with no detected difference in renal function or bleeding complications.