Association of target-controlled versus manually controlled infusion with postoperative recovery outcomes in elderly cardiac surgery patients: an international multi-cohort study

doi:10.1016/j.jclinane.2026.112161

Cardiothoracic & vascular anesthesia

Association of target-controlled versus manually controlled infusion with postoperative recovery outcomes in elderly cardiac surgery patients: an international multi-cohort study

J Clin AnesthPublished 4 Mar 2026Retrospective cohort study

Main finding · ICU LOSResultMD −0.92 days 95% CI −1.68 to −0.17

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Authors' conclusion

TCI is associated with superior intraoperative hemodynamic stability, significantly shorter ICU length of stay, and improved postoperative recovery profiles compared with MCI in elderly cardiac surgery patients.

Study context

Population: Elderly patients (≥65 years) undergoing cardiac surgery, Union Hospital and INSPIRE dataset468 Union, 270 INSPIRE matched
Participants: 1,398 patients

Exposure: Target-controlled infusion (TCI) vs manually controlled infusion of propofol and remifentanil
Outcome: ICU LOS

Methodological detailsinternational, multi-cohort, propensity-score matched 1:1

International
Multi-cohort
Propensity-score matched 1:1

Main finding

As reported in the abstract

MD

−0.92 days

95% CI −1.68 to −0.17

P = 0.017

TCI vs MCI

MD −0.92 days (95% CI −1.68 to −0.17); P = 0.017

INSPIRE validation cohort: shorter ICU stays, MD (95% CI), P: −1.20 days (−2.32 to −0.80), P = 0.036

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower odds with TCI ←→ Higher odds with TCI →	OR (95% CI)
ReintubationUnion cohort	0.512	0.94 (0.90–0.99)
AKI (Union cohort)	0.512	0.84 (0.78–0.91)
In-hospital mortality (Union cohort)	0.512	0.95 (0.92–0.99)
	0.512Odds ratio (log scale)

Reintubation — INSPIRE validation cohort: lower reintubation rates, OR: 0.96 (0.92-0.99) (95% CI)

Intraoperative hemodynamic stability (both cohorts)

TCI associated with superior stability: lower BP variability and reduced burden of hypotension

Original publication

Association of target-controlled versus manually controlled infusion with postoperative recovery outcomes in elderly cardiac surgery patients: an international multi-cohort study. J Clin Anesth. Published 4 March 2026. doi:10.1016/j.jclinane.2026.112161

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