Balanced hydroxyethyl starch solution, as part of intraoperative goal-directed fluid therapy, is associated with better short-term outcomes than dministration of a balanced crystalloid solution in patients having major open abdominal surgery.

The safety of modern hydroxyethyl starch solutions remains debated, with some studies in the intensive care setting have reported potential nephrotoxic effects, while others, performed in a surgical context, have not.

 In a long-term follow-up of a previous trial comparing hydroxyethyl starch solution and balanced crystalloid used as part of intraoperative goal directed fluid therapy in patients undergoing major open abdominal surgery, there was no evidence that one therapy had superior renal function; however, limited power tempers any ability to completely rule out a differenceDisability-free survival was higher in the colloid than in the crystalloid group.