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Postoperative Inotrope and Vasopressor Use Following CABG: Outcome Data from the CAPS‐Care Study
Author(s) -
Williams Judson B.,
Hernandez Adrian F.,
Li Shuang,
Dokholyan Rachel S.,
O’Brien Sean M.,
Smith Peter K.,
Ferguson T. Bruce,
Peterson Eric D.
Publication year - 2011
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2011.01301.x
Subject(s) - medicine , inotrope , perioperative , atrial fibrillation , cardiology , cardiopulmonary bypass , propensity score matching , anesthesia , emergency medicine
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)