Vasopressor use after noncardiac surgery: an international observational study

Area of Science:

• Anesthesiology and Perioperative Medicine
• Critical Care Medicine
• Surgical Outcomes Research

Background:

• Postoperative hypotension following major noncardiac surgery is a significant concern, increasing morbidity, mortality, and healthcare costs.
• Postoperative vasopressor infusions are a common treatment, but their frequency and impact remain largely unknown.
• The study addresses the unknown incidence of vasopressor administration in the postoperative period.

Purpose of the Study:

• To determine the incidence of postoperative vasopressor infusions after major noncardiac surgery.
• To investigate the association between vasopressor use and patient outcomes, including mortality, organ dysfunction, and hospital stay.
• To explore the variability in vasopressor administration practices across different hospitals.

Main Methods:

• An international prospective cohort study involving 25,675 participants from 228 hospitals across 42 countries (October 2020 - October 2023).
• Two cohorts were enrolled: Cohort A (all consecutive patients for 1 week) to assess incidence, and Cohort B (sample of up to 30 patients receiving vasopressors) for outcome analysis.
• Primary outcome was the incidence of postoperative vasopressor infusions; secondary outcomes included in-hospital mortality, organ failure, length of stay, and vasopressor-associated complications.

Main Results:

• The incidence of postoperative vasopressor infusions was 3.9% (770/19,768) in Cohort A, with significant hospital-level variation (0% to 18%).
• Hospital-level variability in vasopressor use persisted even after adjusting for case-mix and procedural factors (median odds ratio: 2.30).
• Postoperative vasopressor infusions were associated with higher in-hospital mortality (15.5%), increased organ failure rates, and longer hospital stays.

Conclusions:

• Administration of postoperative vasopressors after noncardiac surgery demonstrates considerable and unexplained variability across healthcare institutions.
• The use of postoperative vasopressors is strongly associated with adverse patient outcomes, including increased mortality and morbidity.
• These findings highlight the need to standardize postoperative care protocols and investigate the drivers of practice variation.