Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter...

Area of Science:

• Cardiology
• Anesthesiology
• Health Services Research

Background:

• Conflicting evidence surrounds risks and benefits of inotropic therapies in cardiac surgery.
• Variation in clinical practice for inotrope use is understudied.
• Quantifying contributions to inotrope use variation is crucial.

Purpose of the Study:

• To quantify patient-, anesthesiologist-, and hospital-related contributions to variation in intraoperative inotrope use during cardiac surgery.
• To identify factors associated with inotrope administration in a large, multicenter cohort.

Main Methods:

• Observational study of nonemergent adult cardiac surgeries with cardiopulmonary bypass (2014-2019).
• Exclusion of moribund patients, those on mechanical support, or home/preoperative inotropes.
• Analysis of institution-, clinician-, and patient-level variance components for inotrope infusion >60 min or upon transport.

Main Results:

• Over 50% of 51,085 cases received intraoperative inotropes (epinephrine, milrinone, dobutamine, dopamine).
• Variation in inotrope use was 70.6% patient-related, 22.6% institution-related, and 6.8% anesthesiologist-related.
• Institutional affiliation, heart failure, pulmonary disorders, diuretic/digoxin use, and Black race were associated with increased inotrope likelihood.

Conclusions:

• Inotrope use variation in cardiac surgery stems from institutional, clinician, and patient factors.
• Significant variation between institutions and clinicians warrants further investigation.
• Need for research to understand variation's impact on outcomes and develop evidence-based therapies.