Measure ID

Percentage of non-cardiac adult cases in which colloids were not administered intraoperatively.

Measure Type
Available for Provider Feedback
Not applicable - Informational only

There is a lack of consistent evidence to suggest improved survival with the use of colloids as compared to crystalloids in the surgical population. Colloids are also more expensive than crystalloids. It is the expectation that providers will uphold the ASA’s Choosing Wisely program by avoiding colloids and using crystalloid instead when appropriate. Evidence to support the use of hydroxyethyl starch to prevent ovarian hyperstimulation syndrome for In Vitro Fertilization cases has been published and these cases will be excluded.

Measure Time Period

Non-cardiac cases as determined by Procedure Type: Cardiac value code = 0

Success Criteria

Colloids are not administered during the case.

Other Measure Details

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Risk Adjustment

Not applicable.

Provider Attribution

The provider signed in at the time of the colloid administration.

MPOG Concept Used


  • 10018  Albumin 5%
  • 10458  Hetastarch
  • 10459  Pentastarch
  • 10601  Hydroxyethyl Starch 130/0.4 6% in 0.9% Saline (Voluven)
  • 10605  Hydroxyethyl Starch 6% in Lactated Ringers (Hextend)

Patient Position 

  • 50136  Positioning - Patient Position
  • 50137  Positioning - Patient positioned in left lateral decubitus position
  • 50818  Patient positioned in right lateral decubitus position

Blood Administration Concepts:

  • 10489  Packed Red Blood Cells - Autologous
  • 10490  Packed Red Blood Cells - Homologous
  • 10616  Packed Red Blood Cells - Unknown Type

Patient Diagnosis

  • 10500  Ascites

Estimated Blood Loss (EBL)

  • 10499  EBL
MPOG Phenotypes Used
  1. Nolan JP, Mythen MG.  Hydroxyethyl starch: here today, gone tomorrow.  British Journal of Anaesthesia 2013, 111(3): 321–4.  doi:10.1093/bja/aet294.
  2. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. The Cochrane database of systematic reviews. 2013(2):Cd000567.
  3. Schick M, Isbary J, Stuber T, Brugger J, Stumpner J, Schkegel N, Roewer N, Eichelbronner O, Wunder C.  Effects of crystalloids and colloids on liver and intestine microcirculation and function in cecal ligation and puncture induced septic rodents. BMC Gastroenterology 2012, 12:179.
  4. Youssef MA, Al-Inany HG, Evers JL, Aboulghar M. Intra-venous fluids for the prevention of severe ovarian hyperstimulation syndrome. Cochran Database Systematic Reviews 2011, 16(2): CD001302. Doi: 10.1002/14651858.CD001302.pub2.
  5. Ertmer, Christian, Bernhard Zwißler, Hugo Van Aken, Michael Christ, Fabian Spöhr, Axel Schneider, Robert Deisz, and Matthias Jacob. 2018. “Fluid Therapy and Outcome: A Prospective Observational Study in 65 German Intensive Care Units between 2010 and 2011.” Annals of Intensive Care 8 (1): 27.
  6. Futier, Emmanuel, Matthias Garot, Thomas Godet, Matthieu Biais, Daniel Verzilli, Alexandre Ouattara, Olivier Huet, et al. 2020. “Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery: The FLASH Randomized Clinical Trial.” JAMA: The Journal of the American Medical Association 323 (3): 225–36.
  7. Joosten, Alexandre, Amelie Delaporte, Brigitte Ickx, Karim Touihri, Ida Stany, Luc Barvais, Luc Van Obbergh, et al. 2018. “Crystalloid versus Colloid for Intraoperative Goal-Directed Fluid Therapy Using a Closed-Loop System: A Randomized, Double-Blinded, Controlled Trial in Major Abdominal Surgery.” Anesthesiology 128 (1): 55–66.
  8. Joosten, Alexandre, Amélie Delaporte, Julien Mortier, Brigitte Ickx, Luc Van Obbergh, Jean-Louis Vincent, Maxime Cannesson, Joseph Rinehart, and Philippe Van der Linden. 2019. “Long-Term Impact of Crystalloid versus Colloid Solutions on Renal Function and Disability-Free Survival after Major Abdominal Surgery.” Anesthesiology 130 (2): 227–36.
  9. László, Ildikó, Ágnes Janovszky, András Lovas, Viktória Vargán, Nándor Öveges, Tamás Tánczos, András Mikor, et al. 2019. “Effects of Goal-Directed Crystalloid vs. Colloid Fluid Therapy on Microcirculation during Free Flap Surgery: A Randomised Clinical Trial.” European Journal of Anaesthesiology 36 (8): 592–604.
  10. Martin, Greg S., and Paul Bassett. 2019. “Crystalloids vs. Colloids for Fluid Resuscitation in the Intensive Care Unit: A Systematic Review and Meta-Analysis.” Journal of Critical Care 50 (April): 144–54.
Measure Authors
 Measure Author  Institution
 Sachin Kheterpal, MD  University of Michigan
 Nirav Shah, MD  University of Michigan
 Jamie Osborne, RN  University of Michigan
 Genevive Bell  University of Michigan
 MPOG Quality Committee  


Measure Reviewer(s)
Next Review: 2026
 Date Reviewed  Reviewer  Institution Review  QC Vote
 10/23/2023  Brad Taicher, MD  Duke University  Review  Modify


Published Date: 2015
Date Criteria Revision
11/3/2023 Exclusion Modified to exclude liver transplants and cases with preop albumin < 3.5g/dL
10/6/2023 Exclusion Modified to exclude patient age ≤ 18 years & Organ Harvest patients (CPT: 01990)
3/16/2022 Exclusion Modified to use new Cardiac phenotype
9/1/2015   Initial Publication