The researchers note that their findings are similar to studies in critically ill patients and raise questions about the widespread use of these colloids in elective joint arthroplasty procedures.
According to an editorial, hydroxyethyl starch (HES) has been the most commonly used colloid during the past decade, but much of the supporting evidence turned out to be fraudulent. The authors note recent large RCTs have shown that in critically ill patients HES impairs kidney function and coagulation and may even increase mortality, all of which are probably class effects shared by the numerous different solutions. Regulatory agencies already restrict the use of all HES solutions in patients with critical illness, renal failure, or coagulopathy, but this option is still widely available for routine use in patients having surgery. The authors add that this study is an important contribution and the biggest observational study of the safety of colloids in the perioperative period, but the findings are limited by the observational nature of the research and the risk of confounding, thus stronger evidence from large scale RCT comparing colloids and crystalloids head to head in perioperative settings is needed. Nevertheless they suggest that use of HES in particular should be suspended in the interests of patient safety while trial results are awaited. They conclude there needs to be more open acknowledgement that “use of many common interventions—not just colloids—is still based largely on a combination of tradition and limited pathophysiological understanding, both of which can lead to harm in some patients.”