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Comparative Study
. 2011 Nov;26(6):572-8.
doi: 10.1111/j.1540-8191.2011.01301.x. Epub 2011 Sep 26.

Postoperative inotrope and vasopressor use following CABG: outcome data from the CAPS-care study

Judson B Williams  1 , Adrian F Hernandez, Shuang Li, Rachel S Dokholyan, Sean M O'Brien, Peter K Smith, T Bruce Ferguson, Eric D Peterson
Affiliations
Comparative Study

Postoperative inotrope and vasopressor use following CABG: outcome data from the CAPS-care study

Judson B Williams et al. J Card Surg. 2011 Nov.

Abstract

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.

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Figures

Figure 1
Figure 1
Individual inotrope/vasopressor agents as percentage of total Pie chart showing individual inotrope/vasopressor agents given to all study patients, as a percentage of the total overall inotrope usage.
Figure 2
Figure 2
Variation in inotrope/vasopressor use by hospital Plot showing the variation in inotrope/vasopressor use between hospitals. Point estimates and 95% confidence intervals are given for the percentage (y-axis) of patients receiving any inotrope at each study hospital (x-axis).
See this image and copyright information in PMC

References

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