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pandora essence These findings raise questions regarding the widespread use of these colloids in elective joint arthroplasty procedures.IntroductionThe optimal choice of resuscitation fluid has been the subject of intense debate for decades, with definitive conclusions largely lacking.1 2 Several recent publications cautioned that hydroxyethyl starches might be associated with an increased risk of acute kidney injury and renal replacement therapy, especially in septic or critically ill patients.3 4 5 6 7 In June 2013 the US Food and Drug Administration (FDA) released a warning concerning the use of hydroxyethyl starches in patients with sepsis, impaired renal function, or coagulopathies.8 Concurrently, the European Medicines Agencies (EMA) Pharmacovigilance Risk Assessment Committee restricted the indications for hydroxyethyl starch and called for further studies evaluating the risk of complications in elective surgery and trauma patients.9 Others have questioned the choice of hydroxyethyl starch solutions for volume resuscitation in any patient population.10 11 To date, a paucity of data exists regarding the safety of hydroxyethyl starch in the elective, perioperative setting, with advocates and opponents debating their points.12 13 Further, possible alternatives with long track records, such as albumin, have not been without criticism. Albumin, like hydroxyethyl starch, has been associated with impaired coagulation and increased blood product transfusion rates after cardiac surgery14 and has failed to show that it reduces mortality among critically ill, hypovolemic patients.15We set out to investigate the perioperative use of hydroxyethyl starch 6% and albumin 5% (for convenience further on referenced as hydroxyethyl starch and albumin), and their association with adverse outcomes in elective and largely standardized procedures such as lower extremity joint arthroplasties. For this purpose we used a large, nationwide, claims based database including information provided by over 500 different US hospitals pandora essence.