Table 1.
Cohort patient characteristics, clinical care, and outcomes stratified by receipt of vasoactive medications
| Whole Cohort | Received Vasoactive Medication(s) during Hospital Admission | Did Not Receive Any Vasoactive Medication on POD1* | Received Vasoactive Medication(s) on POD1† | |
|---|---|---|---|---|
| n (% of cohort) | 104,063 | 95,992 (92.2) | 72,902 (70.3) | 30,851 (29.7) |
| Patient characteristics | ||||
| Age, mean ± SD, yr | 66.1 ± 10.4 | 66.2 ± 10.4 | 65.9 ± 10.4 | 66.7 ± 10.4 |
| Sex, F, n (% of group) | 29,889 (28.7) | 27,561 (28.7) | 20,231 (27.8) | 9,512 (30.8) |
| Race or ethnicity, n (% of group) | ||||
| White | 80,413 (77.3) | 74,679 (77.8) | 56,464 (77.5) | 23,710 (76.9) |
| Black | 6,706 (6.4) | 6,055 (6.3) | 4,685 (6.4) | 1,999 (6.5) |
| Hispanic | 5,957 (5.7) | 5,758 (6.0) | 3,998 (5.5) | 1,944 (6.3) |
| Other or unknown | 10,987 (10.6) | 9,500 (9.9) | 7,755 (10.6) | 3,198 (10.4) |
| Primary insurance provider, n (% of group) | ||||
| Private | 28,790 (27.7) | 26,438 (27.5) | 21,041 (28.9) | 7,684 (24.9) |
| Medicare | 60,738 (58.4) | 56,292 (58.6) | 41,764 (57.3) | 18,770 (60.8) |
| Medicaid | 8,289 (8.0) | 7,362 (7.7) | 5,803 (8.0) | 2,464 (8.0) |
| Other/unknown/uninsured | 6,246 (6.0) | 5,900 (6.1) | 4,294 (5.9) | 1,933 (6.3) |
| Comorbid disease‡ | ||||
| Malignancy | 2,182 (2.1) | 2,035 (2.1) | 1,481 (2.0) | 699 (2.3) |
| Diabetes with complications | 27,818 (26.7) | 25,638 (26.7) | 18,702 (25.7) | 9,039 (29.3) |
| Cerebrovascular disease | 8,606 (8.3) | 8,014 (8.3) | 5,780 (7.9) | 2,792 (9.0) |
| Acute/chronic renal failure | 23,619 (22.7) | 21,962 (22.9) | 14,657 (20.1) | 8,873 (28.8) |
| COPD | 19,342 (18.6) | 18,237 (19.0) | 12,636 (17.3) | 6,644 (21.5) |
| Acute diagnoses present on admission‡ | ||||
| Congestive heart failure | 36,611 (35.2) | 34,047 (35.5) | 21,891 (30.0) | 14,578 (47.3) |
| Cardiogenic shock | 1,794 (1.7) | 1,707 (1.8) | 642 (0.9) | 1,134 (3.7) |
| Arrhythmia | 24,491 (23.5) | 22,830 (23.8) | 15,531 (21.3) | 8,871 (28.8) |
| Pulmonary edema | 843 (0.8) | 793 (0.8) | 483 (0.7) | 355 (1.2) |
| Type of admission§ | ||||
| Elective | 57,585 (55.3) | 53,509 (55.7) | 41,927 (57.5) | 15,514 (50.3) |
| Urgent/emergent | 45,619 (43.8) | 41,639 (43.4) | 30,390 (41.7) | 15,065 (48.8) |
| Other | 859 (0.8) | 844 (0.9) | 585 (0.8) | 272 (0.9) |
| Clinical care | ||||
| Cardiac surgery type, n (% of group) | ||||
| CABG with CPB | 63,363 (60.9) | 58,817 (61.3) | 45,033 (61.8) | 18,182 (58.9) |
| CABG without CPB | 13,422 (12.9) | 11,978 (12.5) | 10,028 (13.8) | 3,360 (10.9) |
| CABG with valve repair(s) or replacement(s) | 10,203 (9.8) | 9,609 (10.0) | 5,940 (8.2) | 4,202 (13.6) |
| Valve repair(s) or replacement(s), without CABG | 17,075 (16.4) | 15,588 (16.2) | 11,901 (16.3) | 5,107 (16.6) |
| Mechanical ventilation‖ | 96,654 (92.9) | 89,324 (93.1) | 67,094 (92.0) | 29,344 (95.1) |
| Renal replacement therapy during admission | 4,915 (4.7) | 4,695 (4.9) | 2,543 (3.5) | 2,357 (7.6) |
| Receipt of temporary mechanical circulatory support | ||||
| IABP | 5,949 (5.7) | 5,639 (5.9) | 2,618 (3.6) | 3,259 (10.6) |
| Temporary VAD | 314 (0.3) | 311 (0.3) | 63 (0.1) | 242 (0.8) |
| VA ECMO | 203 (0.2) | 202 (0.2) | 34 (0.0) | 154 (0.5) |
| ICU length of stay, median (IQR), d | ||||
| ICU survivors | 3 (1–5) | 3 (1–5) | 2 (1–4) | 4 (2–6) |
| ICU nonsurvivors | 6 (3–14) | 6 (3–14) | 6 (3–14) | 7 (3–15) |
| Patient outcomes | ||||
| New-onset atrial fibrillation, n (% of group) | 22,963 (22.1) | 21,386 (22.3) | 15,324 (21.0) | 7,617 (24.7) |
| New-onset acute renal failure, n (% of group) | 14,842 (14.3) | 16,226 (16.9) | 9,546 (13.1) | 7,588 (24.6) |
| Hospital mortality | 1,934 (1.9) | 1,911 (2.0) | 450 (0.6) | 1,301 (4.2) |
| Location after hospital discharge among survivors, n (% of group) | ||||
| Home | 79,215 (77.6) | 72,388 (76.9) | 58,881 (81.3) | 20,252 (68.5) |
| Nursing facility | 21,623 (21.2) | 20,452 (21.7) | 12,853 (17.7) | 8,749 (29.6) |
| Other acute care hospital | 565 (0.6) | 548 (0.6) | 270 (0.4) | 273 (0.9) |
| Hospice | 130 (0.1) | 128 (0.1) | 57 (0.1) | 73 (0.3) |
Definition of abbreviations: CABG = coronary artery bypass graft; COPD = chronic obstructive pulmonary disease; CPB = cardiopulmonary bypass; IABP = intraaortic balloon pump; ICU = intensive care unit; IQR = interquartile range; POD1 = postoperative Day 1; SD = standard deviation; VAD = ventricular assist device; VA ECMO = venoarterial extracorporeal membrane oxygenation.
Among 103,753 patients who remained alive and admitted to the hospital on POD1, whether or not they received vasoactive medication(s) on other day(s) of hospitalization.
Patients who received at least one vasoactive medication, alone or in combination with others, on the day after index cardiac surgery, whether or not they received vasoactive medications on other days of hospitalization.
As per Abildstrøm (35).
All patients admitted from home who underwent surgery on the first day of hospital admission classified as elective. All others classified as urgent/emergent.
Receipt of preoperative and/or postoperative mechanical ventilation, identified from charge codes.