Perioperative medicine & outcomes
Patient-, Clinician-, and Institution-level Variation in Intraoperative Antihypertensive Use: A Multicenter Observational Analysis
Authors' conclusion
While patient clinical characteristics were major contributors to antihypertensive infusion use across U.S. institutions, clinician- and institution-level factors also appear to influence practice variation.
Study context
- Population
- Adults undergoing cardiac or major noncardiac surgery, 65 US hospitals, Multicenter Perioperative Outcomes Group registry, 2014–202265 hospitals
- Participants
- 89,530 vs 2,644,777
- Exposure
- Cardiac surgery vs Major noncardiac surgery
- Cardiac surgeryn = 89,530
- Major noncardiac surgeryn = 2,644,777
- Outcome
- Antihypertensive infusion administration (>60 cumulative minutes or continued during transport from the operating room); patient-, clinician- and institution-level variation
Methodological detailsmulticentre registry, generalized linear mixed models
- Multicentre registry
- Generalized linear mixed models
Main finding
As reported in the abstract
Antihypertensive infusion >60 cumulative minutes or continued during transport from the OR
- Cardiac: median OR between randomly selected clinicians
- 2.03 (95% CI 1.95-2.11)
- Cardiac: median OR between randomly selected institutions
- 2.77 (95% CI 2.13-3.40)
- Noncardiac: median OR between randomly selected clinicians
- 1.90 (95% CI 1.86-1.93)
- Noncardiac: median OR between randomly selected institutions
- 2.02 (95% CI 1.80-2.24)
Observational data: associations, not effects.
Further findings
Factors associated with antihypertensive infusion, cardiac surgery
| aOR (95% CI) | ||
|---|---|---|
| Valve surgery | 2.59 (2.29–2.92) | |
| Emergent procedure | 2.46 (2.22–2.72) | |
| Maximum intraoperative SBP >200 mmHg | 2.28 (1.99–2.62) | |
| 0.20.5125Adjusted odds ratio (log scale) |
Factors associated with antihypertensive use, major noncardiac surgery
| aOR (95% CI) | ||
|---|---|---|
| Hypertension comorbidity | 1.82 (1.74–1.89) | |
| 0.512Adjusted odds ratio (log scale) |
- Elevated intraoperative SBP (>140 mmHg) among the factors most strongly associated
Original publication
Patient-, Clinician-, and Institution-level Variation in Intraoperative Antihypertensive Use: A Multicenter Observational Analysis. J Cardiothorac Vasc Anesth. Published 21 February 2026. doi:10.
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