Practice Pattern Variability in the Use of Pulmonary Arterial Catheters in Cardiac Surgery

Abstract

Objectives: To quantify intraoperative pulmonary arterial catheter (PAC) use during cardiac surgery and identify hospital-, anesthesiologist-, and patient-level factors associated with PAC utilization.

Design: A cross-sectional, observational study using generalized logistic mixed models to examine variations in PAC use.

Setting: Fifty-three US academic hospitals participating in the Multicenter Perioperative Outcomes Group (MPOG) national registry PARTICIPANTS: 145,343 adult patients undergoing cardiac surgery between January 1, 2016, and December 31, 2022.

Intervention(s): Receipt of intraoperative PAC, defined by ≥60 minutes of physiologically plausible pulmonary arterial pressures.

Measurements & main results: The primary outcome was PAC utilization. Mixed-effects logistic regression quantified fixed-effect predictors, and variation attributable to anesthesiologists and then to anesthesiologists nested within a hospital was characterized using median odds ratio (MOR). Of the 145,343 cardiac surgeries performed across 53 hospitals, 104,626 (72%) included PAC monitoring. PAC use varied widely across hospitals (0-98%) and across anesthesiologists (0-100%). PAC was used most frequently in heart transplants (94%) and lung transplants (87%) and least frequently in pulmonic valve procedures (30%). A patient's likelihood of receiving a PAC was influenced most strongly by hospital (MOR, 15.00; 95% confidence interval [CI], 8.98-28.32), with substantially less variation attributable to an anesthesiologist within the same hospital (MOR, 1.70; 95% CI, 1.61-1.81).

Conclusions: Intraoperative PAC monitoring is used in nearly three-quarters of cardiac surgeries at US academic centers, with hospital practice pattern the factor most closely associated with PAC utilization.

Keywords: cardiac surgery; hemodynamic monitoring; pulmonary arterial catheterization.