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

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Health Services Research

Background:

• Intraoperative pulmonary arterial catheter (PAC) monitoring is a critical tool in cardiac surgery.
• Variations in PAC utilization exist across different institutions and providers.

Purpose of the Study:

• To quantify the use of intraoperative PACs during cardiac surgery.
• To identify factors influencing PAC utilization at the hospital, anesthesiologist, and patient levels.

Main Methods:

• Cross-sectional, observational study utilizing generalized logistic mixed models.
• Analysis of data from 145,343 adult cardiac surgeries across 53 US academic hospitals (2016-2022).
• Characterization of variation using median odds ratio (MOR).

Main Results:

• 72% of cardiac surgeries (104,626/145,343) involved intraoperative PAC monitoring.
• PAC utilization varied significantly by hospital (0-98%) and anesthesiologist (0-100%).
• Hospital practice patterns (MOR=15.00) were the strongest predictor of PAC use, exceeding anesthesiologist-level variation (MOR=1.70).

Conclusions:

• Intraoperative PAC monitoring is utilized in approximately 72% of cardiac surgeries in US academic centers.
• Hospital-level practice variations are the primary driver of differences in PAC utilization.
• Standardizing PAC use based on evidence may improve consistency in cardiac surgical care.