Cardiothoracic & vascular anesthesia
Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice
Authors' conclusion
High-dose opioids predominate in cardiac surgery, with substantial dose variation from case to case. Much of this variation is attributable to practice variability rather than patient or surgical differences.
Study context
- Population
- Adults undergoing nonemergency cardiac surgery with CPB at 30 academic and community hospitals, Multicenter Perioperative Outcomes Group registry, 2014–2021794 anesthesiologists
- Participants
- 59,463 adults · 30 hospitals
- Outcome
- Intraoperative opioid dose (fentanyl equivalents) and its variation attributable to institution, anesthesiologist and patient/case
Methodological detailshierarchical linear modeling
- Hierarchical linear modeling
Main finding
As reported in the abstract
Intraoperative opioid dose
Mean opioid dose, fentanyl mcg equivalents
1139
95% CI 1132–1146; SD 872 µg
Dose variation explainable by institution and anesthesiologist
60%
Median difference in dose between 2 randomly selected anesthesiologists, µg fentanyl (IQR 283-1023 µg)
600
Observational data: associations, not effects.
Further findings
Opioids used (% of cases)
- Fentanyl
- 86%
- Sufentanil
- 16%
- Hydromorphone
- 12%
- Morphine
- 3%
- Opioid-free cases
- 0.6%
Correlates of anesthesiologist opioid dose
- Correlation with frequency of sufentanil infusion use
- r = 0.81
- Correlation with use of nonopioid analgesic techniques
- |r| < 0.3
Original publication
Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice. Anesth Analg. Published 1 May 2025. doi:10.
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