Vasopressor use after noncardiac surgery: an international observational study
Ib Jammer, Peter Martin, Hannah Wunsch, Sophie Debouche, Pierre Harlet, Ramani Moonesinghe, Lui G. Forni, Ben Creagh‐Brown, Meriem Abodun, Souad Bouaoud, Kamel Bouchenak, Hind Saada, Amine Naili, Shruti Chitnis, Marlena Bartmanska, Lip-Yong Choo, Jolene Lim, Estelle Meirau, Rhys Powell, Erica Remedios, Jam Sadullah, Alex Shivarev, Archana Shrivathsa, Marissa Woodburn, Andrew Hughes, Benjamin King-Koi, Anil Mall, Tharindu Vithanage, Baraniselvan Ramalingam, Malcolm Ronald James Bannerman, Clare Margaret Shiner, Trylon Matthew Tsang, David Highton, Steven Ayotte, Allison Kearney, Edward Thornely, Susanna Van Haeringen, Amos Moody, Daniel Kim, Claire Rose, Mahmoud Ugool, Will Zore, Andrew Toner, Patricia Anagnostides, Jodie Jamieson, Hilary Leeson, Susan March, Ronithung Ovung, Alessandra Parini, Toby Shipway, Wai Phen Arthur Teo, Huw Wilkins, Kahina Wotton-Hamrioui, Jodie Jamieson, Sarah Liew, Ashleigh Cargill, Dale Currigan, Edward Gomm, Calvin Lo, Peri Mickle, Marli Smit, Simon Bradbeer, Paul Köglberger, Thomas Geitmann, Laurenz Hell, Johann Knotzer, Dimitar Tonev, Tanislav Ilchev, Dimitrinka Todorova, Karim Ladha, Ciara Hanley, Gabriella Mattina, Janneth Pazmino-Canizares, Bijan Teja, Matteo Parotto, Samareh Ajami, Humara Poonawala, Carlos Jose Perez Rivera, Laura Ramirez, Juan P. Garcia-Mendez, Sharon Idarraga, Ileana Lulic, Gorana Fingler, Jadranka Pavicic Saric, Jakov Jozić, Višnja Nesek Adam, Tatjana Goranović, Marija Josipović, Ida Kožul, Tina Tomić Mahečić, Leonora Bračun, Josip Kovačević, Katarina Lojna, Anton Šarčević, Marko Tripković, Karlo Uroda, Olav Lilleholt Schjørring, Steen Kåre Fagerberg, Birgitte Brandsborg, Zidryne Karaliunaite
Abstract
BACKGROUND: Hypotension after major noncardiac surgery is associated with increased morbidity, mortality, and costs, and is often treated with postoperative vasopressor infusions. The frequency of administration in the postoperative period is unknown. METHODS: This international prospective cohort study was conducted between October 2020 and October 2023. At each hospital, adults undergoing noncardiac surgery were enrolled into two cohorts: all consecutive patients for 1 week (Cohort A) and an additional sample of up to 30 consecutive patients administered postoperative vasopressor infusions within 1 yr (Cohort B). The primary outcome (Cohort A) was the incidence of postoperative vasopressor infusions, defined as any continuous infusion of vasopressors. Secondary outcomes included in-hospital mortality, organ dysfunction, length of hospital stay, and complications associated with postoperative vasopressor infusions (both cohorts). RESULTS: In total, 25 675 participants were enrolled from 228 hospitals across 42 countries. In Cohort A, 770/19 768 (3.9%) participants received postoperative vasopressor infusions, with vasopressor use ranging between 0% and 18% across hospitals (median odds ratio: 2.30 [credible interval 1.96-2.73]). This variability did not alter after adjustment for case-mix and procedural characteristics. For both cohorts, postoperative vasopressor infusions were associated with higher (15.5%) in-hospital mortality, higher rates of organ failure, and longer hospital stay. CONCLUSIONS: Administration of postoperative vasopressors after noncardiac surgery varied across hospitals and was associated with worse outcomes. Variable practice across hospitals could not be explained by differences in case-mix. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/study/NCT03805230, ESAIC tracking ID: ESAIC_CTN_SQUEEZE.