February 2, 2011Acta Anaesthesiologica Scandinavica
Variation in use of peroperative inotropic support therapy in cardiac surgery: time for reflection?
Key result
Peroperative inotrope use varies up to ~8-fold across physicians during cardiac surgery.
- OR 0.3 to 2.3
- 95% CI 0.15-0.61 to 1.83-2.71
- n=3,585
Why the study?
There are no well-established evidence-based clinical guidelines on the most appropriate use of peroperative inotropic support in cardiac surgery.
Population
3585 consecutive cardiac surgery cases from three university hospitals in Western Denmark
Comparison
Use versus non-use of peroperative inotropic support at separation from cardiopulmonary bypass
Design
Population-based observational study using registry data
Authors
Discussion
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Member takes
Implication
Marked interphysician variation in peroperative inotrope use persists; leaves open whether standardization improves outcomes.
Study Design
Type
Observational (n=3,585)
Multicenter
Yes
Structured PICO
P
Population
3,585 consecutive cardiac surgery cases from three university hospitals in Denmark.
E
Exposure
Peroperative inotropic support (infusion of inotropic drugs or norepinephrine at the separation from cardiopulmonary bypass)
O
Outcome
Patient- and procedure-related factors associated with the use of peroperative inotropic support and physician-level variation
Main Result
Effect estimate: OR 0.3 to 2.3 (95% CI 0.15-0.61 to 1.83-2.71)
There is substantial physician-level variation in the use of peroperative inotropic support during cardiac surgery, independent of patient and procedural risk factors, highlighting the need for evidence-based guidelines.
Cite This Study
Nielsen et al. (2011) conducted an observational in Cardiac surgery (n=3,585). Peroperative inotropic support vs. Rest of physicians was evaluated on Use of high-dose inotropic support (OR 0.3 to 2.3, 95% CI 0.15-0.61 to 1.83-2.71). The use of peroperative inotropic support during cardiac surgery varied significantly among physicians, with adjusted odds ratios ranging from 0.3 (95% CI 0.15-0.61) to 2.3 (95% CI 1.83-2.71).