Michael Hong, BMSc '17, PhD Candidate


Michael Hong

Clinical impact of disinvestment in hydroxyethyl starch for patients undergoing coronary artery bypass surgery: a retrospective observational study

-Project supervised by Ava John-Baptiste, PhD and completed in 2017

Short Summary

On April 2, 2013, London Health Sciences Centre (LHSC) stopped purchasing hydroxyethyl starch (HES), commonly used for fluid resuscitation during surgery. We examined the effect of LHSC disinvesting in HES on the length of hospital stay, and the risk of blood transfusion, death, acute kidney injury (AKI), and dialysis. We conducted a historical cohort study using linked health administrative data of patients undergoing coronary artery bypass surgery (CABG) on cardiopulmonary bypass. Propensity scores were used to match patients who did not receive HES (i.e. post-disinvestment) with those who received HES (i.e. pre-disinvestment). Length of hospital stay was analyzed using Fine-Gray proportional hazards regression, while the risk of transfusion, death, AKI, and dialysis were analyzed using conditional logistic regression. Discontinuation of HES was associated with shorter length of hospital stay, as well as a reduced risk of red blood cell transfusion, plasma transfusion, and platelet transfusion. Discontinuation was not associated with in-hospital mortality, AKI, or dialysis. Although our results should be interpreted with caution, our findings indicate that the continued use of HES in CABG should be reconsidered due to the potentially increased risk of need for blood product transfusion and longer length of hospital stay in addition to the higher cost of HES compared to alternative solutions used for fluid resuscitation.

The study was also published in the Canadian Journal of Anesthesia: https://link.springer.com/article/10.1007/s12630-018-1245-5

About Michael

Michael Hong is currently a PhD Candidate in the Department of Epidemiology and Biostatistics, supervised by Dr. Sisira Sarma. He is the first PhD student to enter our program who had completed our BMSc program and begun our MSc program (MSc to PhD transfer).