title: Postoperative inotrope and vasopressor use following CABG: outcome data from the CAPS-care study.
abstract: OBJECTIVE
  Limited clinical data exist to guide practice patterns and evidence-based use of inotropes and vasopressors following coronary artery bypass grafting (CABG).
  
  
  METHODS
  Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) collected detailed perioperative data from 2390 CABG patients between 2004 and 2005 at 55 U.S. hospitals. High-risk elective or urgent CABG patients were eligible for inclusion. We stratified participating hospitals into high, medium, and low tertiles of inotrope use. Hospital-level outcomes were compared before and after risk adjustment for baseline characteristics.
  
  
  RESULTS
  Hospital-level risk-adjusted rates of any inotrope/vasopressor use varied from 100% to 35%. Hospitals in the highest tertile of use had more patients with mitral regurgitation compared to medium- or low-use hospitals (p < 0.001), more previous cardiovascular interventions (p = 0.002), longer cardiopulmonary bypass (p < 0.001), longer cross-clamp times (p < 0.001), and required more transfusions (p = 0.001). Despite these differences, unadjusted outcomes were similar between high-, medium-, and low-use hospitals for operative mortality (4.5% vs. 5.3% vs. 5.2%; p = 0.702), 30-day mortality (4.1% vs. 4.6% vs. 5.0%; p = 0.690), postoperative renal failure (7.2% vs. 9.2% vs. 6.6%; p = 0.142), atrial fibrillation (23.0% vs. 27.2% vs. 25.6%; p = 0.106), and acute limb ischemia (0.6% vs. 0.5% vs. 0.5%; p = 0.945). These similar outcomes persisted after risk adjustment: adjusted OR = 0.97 (95% CI [0.94, 1.00], p = 0.086) for operative mortality and adjusted OR = 1.00 (95% CI [0.96, 1.04], p = 0.974) for postoperative renal failure.
  
  
  CONCLUSIONS
  While considerable variability is present among hospitals in inotrope use following CABG, observational comparison of outcomes did not distinguish a superior pattern; thus, randomized prospective data are needed to better guide clinical practice.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina 27715, USA. judson.williams@duke.edu
authors.forename: Judson B
authors.initials: JB
authors.lastname: Williams
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: Rachel S
authors.initials: RS
authors.lastname: Dokholyan
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Peter K
authors.initials: PK
authors.lastname: Smith
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents