The Effect of Intraoperative Hetastarch Administration on Microvascular Surgical Outcomes

Abstract

Objectives:

The plasma volume expander hetastarch has a suggested subclinical toxicity that increases activated partial thromboplastin time and decreases Factor VIII of the coagulation cascade. The goal of this study was to determine if free tissue transfer patients who received hetastarch intraoperatively had a decreased risk of developing microvascular anastomotic venous thrombosis.

Methods:

The records of all patients undergoing free tissue transfer between January 1, 2009, and May 1, 2013, were selected for retrospective chart review. Background data including patient demographics, surgical indications, and free flap types were collected. Intraoperative medication records were analyzed to determine hetastarch administration. The primary outcome evaluated was anastomotic venous thrombosis. Secondary outcomes assessed included anastomotic arterial thrombosis, hematoma formation, and flap failure.

Results:

During the collection period, a total of 106 patients received hetastarch intraoperatively as a plasma volume expander, compared with 43 who did not. No statistical difference was demonstrated between groups with regard to demographic information, surgical indications, and free flap types. There was no significant difference between groups in the rate of venous thrombosis (P = 1.000), arterial thrombosis (P = 1.000), hematoma formation (P = .4392), or flap failure (P = .5571).

Conclusions:

This study demonstrates that the intraoperative administration of hetastarch during free tissue transfer procedures does not significantly decrease the rate of postoperative venous thrombosis, arterial thrombosis, or free flap failure and, despite its anticoagulatory effects, does not significantly increase the rate of hematoma formation. Therefore, we conclude that utilization of intraoperative hetastarch does not significantly impact the complication rate of microvascular anastomoses.