Patient-, Clinician-, and Institution-level Variation in Intraoperative Antihypertensive Use: A Multicenter...

Area of Science:

• Anesthesiology and Perioperative Medicine
• Cardiovascular Surgery
• Health Services Research

Background:

• Intraoperative antihypertensive medication use is crucial for hemodynamic stability and patient outcomes during major surgeries.
• Limited multicenter data exist regarding the extent of practice variation in administering these medications.

Purpose of the Study:

• To investigate the degree of practice variation in intraoperative antihypertensive infusion use across U.S. hospitals.
• To identify patient, clinician, and institutional factors associated with antihypertensive infusion administration.

Main Methods:

• Retrospective, multicenter observational study using data from the Multicenter Perioperative Outcomes Group national registry (2014-2022).
• Analysis included adult patients undergoing cardiac surgery (n=89,530) and major noncardiac surgery (n=2,644,777).
• Generalized linear mixed models were used to assess variation and associated factors.

Main Results:

• Antihypertensive infusions (>60 minutes) were administered to 13.9% of cardiac surgery patients and 0.89% of noncardiac surgery patients.
• Significant variation in infusion use was observed between clinicians (median odds ratios 2.03 for cardiac, 1.90 for noncardiac) and institutions (2.77 for cardiac, 2.02 for noncardiac).
• Factors like surgery type, emergent procedures, elevated blood pressure, and hypertension comorbidity were associated with increased antihypertensive use.

Conclusions:

• While patient clinical characteristics are primary drivers, clinician and institutional factors significantly influence antihypertensive infusion practices.
• This practice variation underscores the need for evidence-based guidelines and comparative effectiveness research.
• Standardization efforts can improve quality and reduce unexplained variations in perioperative antihypertensive management.