Table 3.
Patient and procedural characteristics of cases stratified by groups of increasing anaesthesiologist etomidate use. ∗Total fluid volume defined as the volumes of crystalloid plus one-and-a-half times colloid administered intraoperative exclusive of PRBCs. All comorbidities are within 1 yr of procedure date. All medications are prescriptions within 30 days of procedure except steroids (1 yr before). †Vasopressors in milligrams norepinephrine equivalents = total amount epinephrine + total amount norepinephrine + (total amount phenylephrine/10) + (total amount dopamine/weight [kg]/2). CAD, coronary artery disease; PVD, peripheral vascular disease; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; CCI, Charlson Comorbidity Index; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; MAC, minimal alveolar concentration; PRBC, packed red blood cells; RVU, relative value unit of main procedure; sd, standard deviation.
| Descriptor | Etomidate use by anaesthesiologist (%) |
|||
|---|---|---|---|---|
| Quartile 1 0 to 4.7 (N=4721) |
Quartile 2>4.7 to 11.1 (N=5029) | Quartile 3>11.1 to 20.4 (N=5027) | Quartile 4>20.4 to 66.7 (N=4937) | |
| Patient characteristics | ||||
| Age (yr), mean (range) | 66.2 (18–100) | 67.3 (18–102) | 67.2 (18–107) | 69.1 (18–102) |
| BMI (kg m−2), mean (sd) | 29.4 (7.9) | 29.3 (7.6) | 29.9 (7.9) | 29.5 (7.8) |
| Female sex, no. (%) | 1993 (42.2) | 2249 (44.7) | 2220 (44.2) | 2283 (46.2) |
| ASA physical status, median (IQR) | 3 (3, 3) | 3 (3, 3) | 3 (3, 3) | 3 (3, 3) |
| Hypertension, no. (%) | 3652 (77.4) | 3830 (76.2) | 3693 (73.5) | 3617 (73.3) |
| Hyperlipidaemia, no. (%) | 2848 (60.3) | 3017 (60.0) | 3043 (60.5) | 2955 (59.9) |
| Diabetes mellitus, no. (%) | 1776 (37.6) | 1903 (37.8) | 2176 (43.3) | 2327 (47.1) |
| On insulin, no. (%) | 1365 (28.9) | 1294 (25.7) | 992 (19.7) | 821 (16.6) |
| CAD, no. (%) | 2426 (51.4) | 2634 (52.4) | 2521 (50.2) | 2701 (54.7) |
| Atrial fibrillation, no. (%) | 1783 (37.8) | 1925 (38.3) | 2136 (42.5) | 1945 (39.4) |
| PVD, no. (%) | 901 (19.1) | 937 (18.6) | 797 (15.9) | 1116 (22.6) |
| Ischaemic stroke, no. (%) | 438 (9.3) | 439 (8.7) | 307 (6.1) | 262 (5.3) |
| COPD, no. (%) | 1094 (23.2) | 1125 (22.4) | 1197 (23.8) | 1220 (24.7) |
| CKD, no. (%) | 1526 (32.3) | 1634 (32.5) | 1789 (35.6) | 1774 (35.9) |
| CCI, median (IQR) | 5 (3, 8) | 5 (3,7) | 5 (3,7) | 5 (3,7) |
| Smoking, no. (%) | 1303 (27.6) | 1270 (25.3) | 1150 (22.9) | 866 (17.5) |
| Beta blocker, no. (%) | 2759 (58.4) | 2711 (53.9) | 1701 (33.8) | 1022 (20.7) |
| ACE inhibitor, no. (%) | 1725 (36.5) | 1881 (37.4) | 1930 (38.4) | 1821 (36.9) |
| Hydralazine/nitrates, no. (%) | 859 (18.2) | 751 (14.9) | 597 (11.9) | 491 (10.0) |
| Aldosterone antagonists, no. (%) | 451 (9.6) | 416 (8.3) | 398 (7.9) | 322 (6.5) |
| Digoxin, no. (%) | 422 (8.9) | 457 (9.1) | 351 (7.0) | 268 (5.4) |
| Steroid use, no. (%) | 1259 (26.7) | 1059 (21.1) | 687 (13.7) | 397 (8.0) |
| Antiplatelet use, no. (%) | 2512 (53.2) | 2430 (48.3) | 1965 (39.1) | 1704 (34.5) |
| Anticoagulant use, no. (%) | 1234 (26.1) | 1357 (27.0) | 1266 (25.2) | 945 (19.1) |
| Ejection fraction, mean (sd) no. (%) | 58.5 (14.3) | 57.3 (14.8) | 54.3 (15.1) | 51.7 (15.1) |
| EF >40% | 2133 (45.2) | 2058 (40.9) | 1810 (36.0) | 1541 (31.2) |
| EF 20–40% | 316 (6.7) | 370 (7.4) | 435 (8.7) | 481 (9.7) |
| EF <20% | 15 (0.3) | 25 (0.5) | 36 (0.7) | 41 (0.8) |
| Missing | 2257 (47.8) | 2576 (51.2) | 2746 (54.6) | 2874 (58.2) |
| Procedural characteristics | ||||
| Emergency status, no. (%) | 258 (5.5) | 340 (6.8) | 468 (9.3) | 598 (12.1) |
| Admission type, no. (%) | ||||
| Ambulatory | 669 (14.2) | 612 (12.2) | 808 (16.1) | 723 (14.6) |
| Same-day admit | 2083 (44.1) | 2372 (47.2) | 2282 (45.4) | 2123 (43.0) |
| Inpatient | 1969 (41.7) | 2045 (40.7) | 1937 (38.5) | 2091 (42.4) |
| Neuraxial anaesthesia, no. (%) | 363 (7.7) | 253 (5.0) | 109 (2.2) | 68 (1.4) |
| Age adjusted MAC, mean (sd) | 0.80 (0.32) | 0.83 (0.34) | 0.85 (0.37) | 0.86 (0.36) |
| Total fluid volume,∗ median (IQR) | 1000 (550, 2000) | 1500 (750, 2500) | 2000 (1000, 3250) | 2500 (1250, 3750) |
| Estimated blood loss (ml), median (IQR) | 0 (0, 150) | 0 (0, 150) | 0 (0, 30) | 0 (0, 0) |
| Urine output (ml), median (IQR) | 0 (0, 290) | 0 (0, 290) | 0 (0, 150) | 0 (0, 0) |
| PRBC units, mean (sd) | 0.14 (0.67) | 0.15 (0.60) | 0.19 (1.02) | 0.25 (0.88) |
| Total vasopressors, mg norepinephrine equivalents,† median (IQR) | 0.15 (0.02, 0.45) | 0.11 (0.01, 0.40) | 0.09 (0.01, 0.42) | 0.07 (0, 0.35) |
| Duration of surgery, min mean (sd) | 167.4 (115.4) | 172.9 (109.4) | 170.7 (115.0) | 160.3 (100.7) |
| Work RVU, median (IQR) | 14.1 (6.8, 20.9) | 14.9 (8.0, 20.9) | 13.6 (7.2, 20.4) | 15.3 (7.5, 20.9) |
| Service, no. (%) | ||||
| Orthopaedic surgery | 636 (13.5) | 1119 (22.3) | 981 (19.5) | 1082 (21.9) |
| Vascular surgery | 544 (11.5) | 603 (12.0) | 391 (7.8) | 911 (18.5) |
| Thoracic surgery | 698 (14.8) | 434 (8.6) | 476 (9.5) | 578 (11.7) |
| Urology | 327 (6.9) | 493 (9.8) | 367 (7.3) | 373 (7.6) |
| General surgery | 528 (11.2) | 349 (6.9) | 308 (6.1) | 193 (3.9) |
| Anaesthesiology | 450 (9.5) | 290 (5.8) | 421 (8.4) | 72 (1.5) |
| Neurosurgery | 326 (6.9) | 319 (6.3) | 293 (5.8) | 234 (4.7) |
| Transplant | 183 (3.9) | 241 (4.8) | 390 (7.8) | 249 (5.0) |
| Acute care surgery | 236 (5.0) | 257 (5.1) | 301 (6.0) | 197 (4.0) |
| Gynaecology | 106 (2.3) | 177 (3.5) | 111 (2.2) | 96 (1.9) |
| Surgical oncology | 130 (2.8) | 118 (2.4) | 116 (2.3) | 73 (1.5) |
| Plastic surgery | 54 (1.1) | 108 (2.2) | 85 (1.7) | 89 (1.8) |
| Radiology | 79 (1.7) | 117 (2.3) | 41 (0.8) | 4 (0.1) |
| ENT | 17 (0.4) | 38 (0.8) | 80 (1.6) | 72 (1.5) |
| Colorectal | 16 (0.3) | 32 (0.6) | 51 (1.0) | 60 (1.2) |
| Burn | 35 (0.7) | 64 (1.3) | 28 (0.6) | 7 (0.1) |
| Other | 260 (5.5) | 127 (2.5) | 100 (2.0) | 92 (1.9) |
| Missing | 96 (2.0) | 143 (2.8) | 487 (9.7) | 555 (11.2) |