BACKGROUND AND GOALS 
The use of 6% hydroxyethyl starch 130/0.4 (HES) in patients with severe sepsis is associated with increased acute kidney injury (AKI), coagulopathy and mortality. Patients receiving HES during major surgery may be different from patients with severe sepsis, and fluid resuscitation with HES may not be associated with adverse long-term outcomes in these patients.
We aimed to compare the occurrence of postoperative AKI, coagulopathy and mortality in patients who received HES with those who did not receive HES for major haemorrhage in surgery for pelvic bone tumours.

MATERIALS AND METHODS
After Ethics Committee approval, records of 102 patients between January 2011 and June 2016 were reviewed. Patients were classified as those who received HES during surgery and those who did not.
Primary outcome- A composite end-point of the number of patients developing postoperative AKI (RIFLE Stage Injury or Failure by creatinine criteria) OR coagulopathy (platelet count < 80,000/cu mm or INR > 1.5 or APTT > 1.5 times control value) OR death prior to hospital discharge.
Secondary outcome- the number of patients with AKI, coagulopathy and mortality during the hospital stay and at 90 days after surgery.
Preoperative values of Serum creatinine, Platelet count, INR and APTT were compared to the worst post-operative values during the hospital stay. Values of Serum creatinine and survival status at 90 days after surgery were also recorded.
Data was analyzed using Chi square test / Fishers exact test, independent “t” test and Multivariate binary logistic regression analysis. P-value < 0.05 was considered statistically significant.

RESULTS AND DISCUSSION
42 patients received HES (including 12 who received gelatin in addition), while 60 patients did not receive HES (of these, 52 patients received gelatin and 8 received only crystalloid). 37 patients in HES group and 46 patients in the NON HES group were analysed for composite end point which was similar in both groups of patients (p – 0.934). Hospital mortality (HES, 1 /42 vs. Non-HES, 1/60) was similar. No difference was observed in the other secondary outcomes.

 
CONCLUSION
6% HES (130/0.4) is not significantly associated with AKI, coagulopathy or mortality during hospital stay or at 90 days after surgery.  Data from this study could be used to justify undertaking a randomised controlled trial of 6% HES 130/0.4 for fluid resuscitation during major surgical haemorrhage to determine its safety and efficacy


03 / Effect of 6% Hydroxy Ethyl Starch 130/0.4 (HES) on renal function, coagulation and mortality in patients undergoing hemipelvectomy surgery involving major haemorrhage- a retrospective study.