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The epidemiology of postoperative dobutamine and phosphodiesterase inhibitors after adult elective cardiac surgery and its impact on the length of hospital stay: a post hoc analysis from the multicenter retrospective observational study

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Abstract

The optimal administration of inotrope after cardiac surgery is unknown. This study aimed to investigate the impact of postoperative inotrope on clinical outcomes in adult elective cardiac surgery patients. Data from the Blood Pressure and Relative Optimal Target after Heart Surgery in Epidemiologic Registry study were analyzed, employing propensity score considering the hospital of admission. The primary outcome was the length of hospital stay evaluated using quantile regression. Secondary outcomes were kidney injury progression, renal replacement therapy, atrial fibrillation, mortality, mechanical ventilation duration, and length of intensive care unit (ICU) stay. Among 870 patients from 14 ICUs in Japan, 535 received inotropes within 24 h of ICU admission, with usage rates ranging from 40 to 100% among facilities. After propensity score matching, 218 patients were included in each group. The inotrope group had a significantly longer hospital stay compared to the control group (16 days vs. 14 days; median difference 1.78 [95% confidence interval [CI] 0.31–3.24]; p = 0.018). However, no significant differences were observed in the secondary outcomes, except for mechanical ventilation duration. The results of the sensitivity analysis using a mixed-effects quantile regression analysis considering the hospital of admission for length of hospital stay in the original cohort were consistent with the results of the propensity analyses (median difference in days, 2.35 [95% CI, 0.35–4.36]; p = 0.022). The use of inotropes within 24 h of ICU admission in adult elective cardiac surgery patients was associated with an extended hospitalization period of approximately 2 days, without offering any prognostic benefit. Clinical trial registration: UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm, UMIN000037074.

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Availability of data and material

The data supporting the findings of this study are available from the corresponding author, TY, upon reasonable request.

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Acknowledgements

We would like to thank all colleagues in the BROTHER study participating hospitals who performed the extensive data entry. The BROTHER study group: Kameda Medical Center: Yuki Kotani; Jikei University School of Medicine: Takahiro Koga; Okinawa Chubu Hospital: Izumi Nakayama; Tottori University Faculty of Medicine: Masato Nakasone; Wakayama Medical University: Mami Shibata; Hokkaido University Hospital: Tomonao Yoshida; Kobe City Medical Center General Hospital: Akihisa Taguchi, Daisuke Kawakami; Hirosaki University Graduate School of Medicine: Noriko Mikami, Junichi Saito, Mirei Kubota, Tsubasa Oyama; Kurashiki Central Hospital: Jun Kamei; Yokohama City Minato Red Cross Hospital: Isao Nagata, Shinsuke Karatsu; Tokyo Bay Urayasu Ichikawa Medical Center: Naoki Yamaguchi; Yokohama City University Hospital: Takayuki Kariya; Iwate Prefectural Central Hospital: Hiroshi Nashiki; and Hiroshima Citizens Hospital, Hiroshima: Koji Kido, Hiroki Omiya.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan

    Takuo Yoshida, Atsushi Goto & Takahiro Mihara

  2. Intensive Care Unit, Department of Emergency Medicine, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471, Japan

    Takuo Yoshida

  3. Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama City, Kanagawa, 236-0004, Japan

    Satoru Shinoda

  4. Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan

    Yuki Kotani

  5. Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy

    Yuki Kotani

  6. Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan

    Takahiro Mihara

Authors
  1. Takuo Yoshida
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Consortia

the BROTHER study group

  • Yuki Kotani
  • , Takahiro Koga
  • , Masato Nakasone
  • , Mami Shibata
  • , Tomonao Yoshida
  • , Akihisa Taguchi
  • , Daisuke Kawakami
  • , Noriko Mikami
  • , Junichi Saito
  • , Mirei Kubota
  • , Tsubasa Oyama
  • , Jun Kamei
  • , Isao Nagata
  • , Shinsuke Karatsu
  • , Naoki Yamaguchi
  • , Takayuki Kariya
  • , Hiroshi Nashiki
  • , Koji Kido
  •  & Hiroki Omiy

Contributions

TY had full access to all data in the study and takes responsibility for the integrity of the data. Study concept and design: TY, TM, SS, YK, and AG. Acquisition of data: TY and YK. Analysis and interpretation of data: TY, TM, SS, YK, and AG. Drafting of the manuscript: TY. Critical revision of the manuscript for important intellectual content: TY, TM, SS, YK, and AG.

Corresponding author

Correspondence to Takuo Yoshida.

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Conflict of interest

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Ethics approval and consent to participate

The ethics committee of Kameda Medical Center approved this study (No. 19–013), and all the ethics committees of the participating hospitals approved an opt-out method of informed consent. As this was a retrospective cohort study, we applied the opt-out method of informed consent for participation.

Consent for publication

As this was a retrospective cohort study, we applied the opt-out method of informed consent for publication.

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The members of the BROTHER study group are mentioned in Acknowledgements section.

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Yoshida, T., Goto, A., Shinoda, S. et al. The epidemiology of postoperative dobutamine and phosphodiesterase inhibitors after adult elective cardiac surgery and its impact on the length of hospital stay: a post hoc analysis from the multicenter retrospective observational study. Heart Vessels 39, 438–445 (2024). https://doi.org/10.1007/s00380-023-02349-3

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  • DOI: https://doi.org/10.1007/s00380-023-02349-3

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