Clinical InvestigationSurgeryVariation in perioperative vasoactive therapy in cardiovascular surgical care: Data from the Society of Thoracic Surgeons
Section snippets
Data sources
Clinical data for the STS NCD were collected using methods described fully elsewhere.6 Briefly, the STS NCD was established in 1987 as a multicenter clinical repository for quality improvement and clinical research. The STS NCD collects data from approximately two thirds of all US hospitals with cardiothoracic surgical programs and contains detailed data on patient demographics, clinical profile, and immediate outcomes for >3 million procedures. Data definitions are standardized, and site data
Results
There were 2,390 cases that fulfilled the selection criteria and were available for data abstraction from 48 STS database participants serving 55 hospitals (median patients per hospital 50, range 8-60). The missing rate for data was low, with <0.1% missing for any inotrope/vasopressor or vasodilator use. CAPS-Care participating hospitals were generally similar compared with other STS hospitals in baseline clinical and institutional characteristics with the exception of volume of cases, by
Discussion
To our knowledge, this is the largest examination of vasoactive therapy use in a contemporary cohort of high-risk patients undergoing CABG. There is a >2-fold variation across hospitals in the use of vasoactive therapies, even with adjustment for case mix. This significant hospital-level variation in inotrope/vasopressor and vasodilator use indicates an important area of research to establish an evidence-based approach for the early perioperative period. As with other areas of medicine, the
Conclusions
There is substantial variation in the use of vasoactive therapies in high-risk CABG patients. Although much of this is related to preexisting clinical conditions and complexity of procedures, it is likely that this variation also indicates an important area to better clarify best practice and contribute a new component to the ongoing quality improvement effort in CABG surgery. Prospective studies including randomized placebo-controlled clinical trails are needed to develop evidence-based
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