Impact of perioperative blood pressure variability on health resource utilization after cardiac surgery: an analysis of the ECLIPSE trials.
OBJECTIVE
To examine the impact of blood pressure control on hospital health resource utilization using data from the ECLIPSE trials.


DESIGN
Post-hoc analysis of data from 3 prospective, open-label, randomized clinical trials (ECLIPSE trials).


SETTING
Sixty-one medical centers in the United States.


PARTICIPANTS
Patients 18 years or older undergoing cardiac surgery.


INTERVENTIONS
Clevidipine was compared with nitroglycerin, sodium nitroprusside, and nicardipine.


MEASUREMENTS AND MAIN RESULTS
The ECLIPSE trials included 3 individual randomized open-label studies comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood pressure control was assessed as the integral of the cumulative area under the curve (AUC) outside specified systolic blood pressure ranges, such that lower AUC represents less variability. This analysis examined surgery duration, time to extubation, as well as intensive care unit (ICU) and hospital length of stay (LOS) in patients with AUC≤10 mmHg×min/h compared to patients with AUC>10 mmHg×min/h. One thousand four hundred ten patients were included for analysis; 736 patients (52%) had an AUC≤10 mmHg×min/h, and 674 (48%) had an AUC>10 mmHg×min/h. The duration of surgery and ICU LOS were similar between groups. Time to extubation and postoperative LOS were both significantly shorter (p = 0.05 and p<0.0001, respectively) in patients with AUC≤10. Multivariate analysis demonstrates AUC≤10 was significantly and independently associated with decreased time to extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard ratio 1.221, p = 0.0006).


CONCLUSIONS
Based on data derived from the ECLIPSE studies, increased perioperative BP variability is associated with delayed time to extubation and increased postoperative LOS.
['Aronson|Solomon|S|', 'Levy|Jerrold H|JH|', 'Lumb|Philip D|PD|', 'Fontes|Manuel|M|', 'Wang|Yamei|Y|', 'Crothers|Tracy A|TA|', 'Sulham|Katherine A|KA|', 'Navetta|Marco S|MS|']
D000367:Age Factors D000368:Aged D001794:Blood Pressure D006348:Cardiac Surgical Procedures D005260:Female D006295:Health Resources D006801:Humans D008297:Male D008875:Middle Aged D059035:Perioperative Period D011182:Postoperative Care D011446:Prospective Studies D018570:Risk Assessment D012737:Sex Factors D012959:Socioeconomic Factors
health resources antihypertensive agents hemostasis perioperative hypertension thoracic surgery