TY - JOUR
T1 - Postoperative inotrope and vasopressor use following CABG
T2 - Outcome data from the CAPS-Care study
AU - Williams, Judson B.
AU - Hernandez, Adrian F.
AU - Li, Shuang
AU - Dokholyan, Rachel S.
AU - O'Brien, Sean M.
AU - Smith, Peter K.
AU - Ferguson, T. Bruce
AU - Peterson, Eric D.
PY - 2011/11
Y1 - 2011/11
N2 - Background/Aim: Limited clinical data exist to guide practice patterns and evidence-based use of inotropes and vasopressors following coronary artery bypass grafting (CABG). Methods: Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) collected detailed perioperative data from 2390 CABG patients between 2004 and 2005 at 55 U.S. hospitals. High-risk elective or urgent CABG patients were eligible for inclusion. We stratified participating hospitals into high, medium, and low tertiles of inotrope use. Hospital-level outcomes were compared before and after risk adjustment for baseline characteristics. Results: Hospital-level risk-adjusted rates of any inotrope/vasopressor use varied from 100% to 35%. Hospitals in the highest tertile of use had more patients with mitral regurgitation compared to medium- or low-use hospitals (p < 0.001), more previous cardiovascular interventions (p = 0.002), longer cardiopulmonary bypass (p < 0.001), longer cross-clamp times (p < 0.001), and required more transfusions (p = 0.001). Despite these differences, unadjusted outcomes were similar between high-, medium-, and low-use hospitals for operative mortality (4.5% vs. 5.3% vs. 5.2%; p = 0.702), 30-day mortality (4.1% vs. 4.6% vs. 5.0%; p = 0.690), postoperative renal failure (7.2% vs. 9.2% vs. 6.6%; p = 0.142), atrial fibrillation (23.0% vs. 27.2% vs. 25.6%; p = 0.106), and acute limb ischemia (0.6% vs. 0.5% vs. 0.5%; p = 0.945). These similar outcomes persisted after risk adjustment: adjusted OR = 0.97 (95% CI [0.94, 1.00], p = 0.086) for operative mortality and adjusted OR = 1.00 (95% CI [0.96, 1.04], p = 0.974) for postoperative renal failure. Conclusion: While considerable variability is present among hospitals in inotrope use following CABG, observational comparison of outcomes did not distinguish a superior pattern; thus, randomized prospective data are needed to better guide clinical practice. (J Card Surg 2011;26:572-578)
AB - Background/Aim: Limited clinical data exist to guide practice patterns and evidence-based use of inotropes and vasopressors following coronary artery bypass grafting (CABG). Methods: Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) collected detailed perioperative data from 2390 CABG patients between 2004 and 2005 at 55 U.S. hospitals. High-risk elective or urgent CABG patients were eligible for inclusion. We stratified participating hospitals into high, medium, and low tertiles of inotrope use. Hospital-level outcomes were compared before and after risk adjustment for baseline characteristics. Results: Hospital-level risk-adjusted rates of any inotrope/vasopressor use varied from 100% to 35%. Hospitals in the highest tertile of use had more patients with mitral regurgitation compared to medium- or low-use hospitals (p < 0.001), more previous cardiovascular interventions (p = 0.002), longer cardiopulmonary bypass (p < 0.001), longer cross-clamp times (p < 0.001), and required more transfusions (p = 0.001). Despite these differences, unadjusted outcomes were similar between high-, medium-, and low-use hospitals for operative mortality (4.5% vs. 5.3% vs. 5.2%; p = 0.702), 30-day mortality (4.1% vs. 4.6% vs. 5.0%; p = 0.690), postoperative renal failure (7.2% vs. 9.2% vs. 6.6%; p = 0.142), atrial fibrillation (23.0% vs. 27.2% vs. 25.6%; p = 0.106), and acute limb ischemia (0.6% vs. 0.5% vs. 0.5%; p = 0.945). These similar outcomes persisted after risk adjustment: adjusted OR = 0.97 (95% CI [0.94, 1.00], p = 0.086) for operative mortality and adjusted OR = 1.00 (95% CI [0.96, 1.04], p = 0.974) for postoperative renal failure. Conclusion: While considerable variability is present among hospitals in inotrope use following CABG, observational comparison of outcomes did not distinguish a superior pattern; thus, randomized prospective data are needed to better guide clinical practice. (J Card Surg 2011;26:572-578)
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U2 - 10.1111/j.1540-8191.2011.01301.x
DO - 10.1111/j.1540-8191.2011.01301.x
M3 - Article
C2 - 21951076
AN - SCOPUS:82455212056
SN - 0886-0440
VL - 26
SP - 572
EP - 578
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
IS - 6
ER -