Variation in perioperative vasoactive therapy in cardiovascular surgical care: Data from the Society of Thoracic Surgeons

Background: The appropriate use of vasoactive cardiovascular drugs in high-risk coronary artery bypass grafting (CABG) patients has not been well characterized. Methods: We performed a detailed chart analysis on 2,390 randomly selected patients undergoing CABG between January 2004 and June 2005 at 55 hospitals participating in the Society of Thoracic Surgeons' National Adult Cardiac Surgery Database. Patients were eligible if they had elective/urgent CABG with an ejection fraction (EF) <40%, or if they had an elective or urgent CABG at ≥65 years with diabetes, or a glomerular filtration rate <60 mL/min per 1.73 m². Logistic regression modeling was used to determine predictors of and provide risk-adjusted frequencies of postoperative vasoactive therapies. Results: Vasoactive therapy was used in 90% of patients. Inotropes/vasopressors were used in 28% (668), vasodilators in 18% (430), and the combination in 43% (1,037). Predictors of any inotrope use were preoperative atrial fibrillation (odds ratio [OR] 1.48), other arrhythmia (OR 2.09), EF (OR 1.09 per 5-unit decrease), severe mitral regurgitation (OR 2.56), 3-vessel coronary artery disease (OR 1.35), New York Heart Association class IV (1.38), on-pump (OR 1.86), other procedure (OR 2.51), and peripheral vascular disease (OR 1.28) (all OR P < .05). Hospital-level risk-adjusted rates of any inotrope use varied significantly from 100% to 35% (P < .01) and vasodilator rates varied from 100% to 10% (P < .01). Conclusions: There is marked hospital variation in the use of vasoactive therapies in high-risk CABG patients in clinical practice, indicating an important area for further research to better clarify best practice.