Cardiothoracic & vascular anesthesia
Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis
Authors' conclusion
Variation in inotrope use during cardiac surgery is attributable to the institution and to the clinician, in addition to the patient.
Study context
- Population
- Adults undergoing nonemergent cardiac surgery with CPB, 2014–2019; excluding moribund, mechanical circulatory support, or preoperative/home inotropes611 anesthesiologists
- Participants
- 51,085 adults · 29 hospitals
- Outcome
- Inotrope infusion (epinephrine, dobutamine, milrinone, dopamine) for >60 consecutive min intraoperatively or ongoing on transport from the OR
Methodological detailsacademic and community hospitals, variance components analysis
- Academic and community hospitals
- Variance components analysis
Main finding
As reported in the abstract
Inotrope use and sources of variation
- Cases receiving ≥1 intraoperative inotrope
- 27,033 (52.9%)
- Epinephrine
- 21,796 (42.7%)
- Milrinone
- 6,360 (12.4%)
- Dobutamine
- 2,000 (3.9%)
- Dopamine
- 602 (1.2%)
- Variation attributable to institution
- 22.6%
- Variation attributable to primary attending anesthesiologist
- 6.8%
- Variation attributable to patient
- 70.6%
- Adjusted median OR, 2 random clinicians
- 1.73
- Adjusted median OR, 2 random institutions
- 3.55
Observational data: associations, not effects.
Further findings
Factors associated with inotrope use
| aOR (95% CI) | ||
|---|---|---|
| Institutional medical school affiliation | 6.2 (1.39–27.8) | |
| HF | 2.60 (2.46–2.76) | |
| Pulmonary circulation disorder | 1.72 (1.58–1.87) | |
| Loop diuretic home medication | 1.55 (1.42–1.69) | |
| Black race | 1.49 (1.32–1.68) | |
| Digoxin home medication | 1.48 (1.18–1.86) | |
| 0.050.21520Adjusted odds ratio (log scale) |
Original publication
Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis. Anesthesiology. Published 24 April 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →