Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice.

Area of Science:

• Anesthesiology
• Cardiac Surgery
• Pharmacology

Background:

• High-opioid anesthesia was historically standard for cardiac surgery.
• Current trends explore multimodal analgesia and low-opioid techniques.
• Typical opioid doses and influencing factors in cardiac surgery remain unclear.

Purpose of the Study:

• To determine typical intraoperative opioid doses in adult cardiac surgery.
• To investigate the influence of patient, anesthesiologist, and institutional factors on opioid dose variation.
• To identify opportunities for optimizing opioid use in cardiac surgery.

Main Methods:

• Retrospective review of nonemergency adult cardiac surgeries requiring cardiopulmonary bypass (2014-2021).
• Data from 30 academic and community hospitals in the Multicenter Perioperative Outcomes Group registry.
• Hierarchical linear modeling to analyze opioid dose variation attributed to institution, anesthesiologist, patient, and case specifics.

Main Results:

• A mean of 1139 mcg fentanyl equivalents of opioid was administered across 59,463 cases.
• Significant dose variation observed (SD, 872 µg); 60% of variation explained by institution and anesthesiologist.
• Anesthesiologist's opioid dose correlated with sufentanil infusion use (r=0.81) but not nonopioid analgesic techniques (|r|<0.3).

Conclusions:

• High-dose opioids remain prevalent in cardiac surgery, exhibiting considerable case-to-case variability.
• Practice variability among institutions and anesthesiologists, rather than patient or surgical factors, accounts for most of this variation.
• There is a significant opportunity to optimize opioid utilization in cardiac surgical anesthesia.