We thank Drs. Pizov and Gelman for their interesting comments regarding our two recent publications, which compared the effects of crystalloids and colloids on short- and long-term outcomes in high-risk surgical patients.1,2 Although we agree that surgical complexity could be a potential confounding factor for immediate postoperative complications and for its long-term consequences, we do not think that patients in the crystalloid group underwent more complex surgeries than those randomized to the colloid group. Indeed, beyond the surgical time, we have no data to support this hypothesis. Surgical procedures and incidences of high-risk surgery were comparable in the two groups, and blood loss, which is often considered as a marker of surgical complexity, was also not different between the two groups. A longer surgical time did not necessarily indicate a more complex procedure. As an example, when reviewing the 102 patients who underwent a gastrointestinal anastomosis, surgical time was not different between those experiencing a postoperative anastomotic leakage and those who did not (240 min [204 to 387] vs. 268 min [185 to 336], respectively; P = 0.850). In contrast, fluid balance was significantly higher among patients developing an anastomotic leakage compared to those who did not (6.0 ml · kg–1 · h–1 [5.1 to 8.4] vs. 3.1 ml · kg–1 · h–1 [1.7 to 5.0], respectively; P = 0.021). These data confirm the impact of intraoperative fluid volume administration on the incidence of postoperative complications independently to the length of surgery. Although we cannot formally exclude that a longer operating time might have contributed to our results, we remain confident that the results we observed are mainly related to the type of fluid used to optimize hemodynamic management in our high-risk surgical population. Finally, the finding that hydroxyethylstarch solutions did not have a negative impact on long-term outcome (arguably what is most important to the patients), in line with the results of other recent articles,3,4 is reassuring with regard to the use of these solutions for intraoperative fluid management of patient undergoing high-risk abdominal surgery.
Dr. Joosten reports consulting for Edwards Lifesciences (Irvine, California). Dr. Rinehart reports ownership interest in Sironis (Newport Beach, California), a company developing closed-loop systems, and consulting for Edwards Lifesciences. Dr. Van der Linden has received, within the past 5 yr, fees for lectures and consultancies from Fresenius Kabi GmbH (Bad Homburg, Germany) and Janssen-Cilag SA (Olen, Belgium).