title: Health outcomes with and without use of inotropic therapy in cardiac surgery: results of a propensity score-matched analysis.
abstract: BACKGROUND
  Inotropes used to obtain short-term hemodynamic benefits in cardiac surgery may carry a risk of increased myocardial ischemia and adverse outcomes. This study investigated the association between intra- and postoperative use of inotropes and mortality and postoperative complications.
  
  
  METHODS
  A historic cohort study using prospective data from the Western Denmark Heart Registry on 6,005 consecutive cardiac surgery cases from three university hospitals. Propensity matching on pre- and intraoperative variables was used to identify a subgroup of patients receiving inotropic therapy (n = 1,170) versus comparable nonreceivers (n = 1,170) for outcome analysis.
  
  
  RESULTS
  Two thousand ninety-seven patients (35%) received inotropic therapy; 3,908 (65%) did not receive any inotropic or vasopressor support perioperatively. Among propensity-matched cohort including 2,340 patients 30-day mortality was 3.2% and 1-yr mortality was 7.6%. In the matched cohort, patients exposed to inotropes had a higher 30-day mortality (adjusted hazards ratio, 3.7; 95% CI, 2.1 to 6.5) as well as a higher 1-yr mortality rate (adjusted hazards ratio, 2.5; 95% CI, 1.8 to 3.5) compared with nonreceivers. Among propensity-matched, the following absolute events rates were observed: myocardial infarction 2.4%, stroke 2.8%, arrhythmia 35%, and renal replacement therapy 23.9%. Inotropic therapy was independently associated with postoperative myocardial infarction (adjusted odds ratio, 2.1; 95% CI, 1.4 to 3.0), stroke (adjusted odds ratio, 2.4; 95% CI, 1.4 to 4.3), and renal replacement therapy (adjusted odds ratio, 7.9; 95% CI, 3.8 to 16.4).
  
  
  CONCLUSIONS
  Use of intra- and postoperative inotropes was associated with increased mortality and major postoperative morbidity.
authors.affiliation: From the Department of Anesthesiology and Intensive Care (D.V.N., C.-J.J.) and Department of Clinical Epidemiology (M.K.H., S.P.J.), Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesia and Intensive Care, Odense University Hospital, Odense, Denmark (M.H.); and Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark (K.H.).
authors.forename: Dorthe Viemose
authors.initials: DV
authors.lastname: Nielsen
authors.forename: Malene Kærslund
authors.initials: MK
authors.lastname: Hansen
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Mads
authors.initials: M
authors.lastname: Hansen
authors.forename: Karsten
authors.initials: K
authors.lastname: Hindsholm
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Jakobsen
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods* / Q000401:mortality*; D011183:Postoperative Complications / Q000139:chemically induced / Q000401:mortality* / Q000517:prevention & control; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents