Health Outcomes with and without Use of Inotropic Therapy in Cardiac Surgery
Key result
Intra- and postoperative use of inotropes during cardiac surgery was associated with higher 30-day mortality (HR 3.7; 95% CI 2.1-6.5) compared with nonreceivers.
Why the study?
Does intra- and postoperative inotropic therapy increase mortality and postoperative complications in patients undergoing cardiac surgery?
Population
6,005 consecutive cardiac surgery cases from three university hospitals in Western Denmark.
Comparison
Intra- and postoperative inotropic therapy vs No inotropic or vasopressor support…
Design
Cohort
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Inotrope use should not yet change cardiac surgery practice; leaves open whether the mortality association is causal or confounded.
Key Points
- To evaluate the association between perioperative inotropic therapy and risks of mortality and postoperative complications in cardiac surgery patients.
- Historic cohort study using prospective data from the Western Denmark Heart Registry on 6,005 consecutive cardiac surgery patients across three university hospitals.
- Propensity score matching based on pre- and intraoperative variables yielded 1,170 matched pairs (n = 2,340) comparing inotropic therapy recipients to nonreceivers.
- Inotropic therapy was associated with significantly increased 30-day mortality (adjusted HR 3.7; 95% CI, 2.1 to 6.5) and 1-year mortality (adjusted HR 2.5; 95% CI, 1.8 to 3.5).
- Receiving inotropes was independently associated with higher odds of postoperative myocardial infarction (adjusted OR 2.1; 95% CI, 1.4 to 3.0), stroke (adjusted OR 2.4; 95% CI, 1.4 to 4.3), and renal replacement therapy (adjusted OR 7.9; 95% CI, 3.8 to 16.4).
Study Design
Type
Cohort (n=6,005)
Multicenter
Yes
Structured PICO
Does intra- and postoperative inotropic therapy increase mortality and postoperative complications in patients undergoing cardiac surgery?
P
Population
6,005 consecutive cardiac surgery cases from three university hospitals in Denmark, analyzed using a propensity-matched cohort of 2,340 patients to assess 30-day and 1-year outcomes.
E
Exposure
Intra- and postoperative inotropic therapy
C
Comparator
No inotropic or vasopressor support perioperatively
O
Outcome
Mortality (30-day and 1-year) and postoperative complications (myocardial infarction, stroke, arrhythmia, and renal replacement therapy)hard clinical
Main Result
Hazard Ratio: 3.7 (95% CI 2.1–6.5)
Intra- and postoperative use of inotropes in cardiac surgery is associated with significantly increased risks of short- and long-term mortality, as well as major postoperative morbidity.
Cite This Study
Nielsen et al. (2014) conducted a cohort in Cardiac surgery (n=6,005). Intra- and postoperative use of inotropes vs. Nonreceivers (no inotropic or vasopressor support) was evaluated on 30-day mortality (HR 3.7, 95% CI 2.1 to 6.5). Intra- and postoperative use of inotropes during cardiac surgery was associated with higher 30-day mortality (HR 3.7; 95% CI 2.1-6.5) compared with nonreceivers.