Evidence map›Paper›PMID 35101244›Full record

ArticleBritish journal of anaesthesia2022

Multicentre analysis of practice patterns regarding benzodiazepine use in cardiac surgery.

Allison M Janda, Jessica Spence, Timur Dubovoy, Emilie Belley-Côté, Graciela Mentz, Sachin Kheterpal, Michael R Mathis

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in British journal of anaesthesia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Observational
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  4. Review
  5. Observational
  6. Article
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  9. Observational
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  11. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Allison M JandaDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: ajanda@med.umich.edu.
Jessica SpenceDepartments of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Timur DubovoyDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Emilie Belley-CôtéPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada; Divisions of Cardiology and Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Graciela MentzDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Sachin KheterpalDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Michael R MathisDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.

Funding

University of Michigan Anesthesiology Post-Doctoral Research Training ProgramT32GM103730 · NIGMS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Chad M Brummett, SACHIN KHETERPAL · 2014 to 2026
$1.9M
Early Diagnosis of Heart Failure: A Perioperative Data-Driven ApproachK01HL141701 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MATHIS, MICHAEL ROBERT · 2018 to 2022
$862k
NHLBI NIH HHS K01 HL141701NIGMS NIH HHS T32 GM103730
6 · The paper itself

Abstract

backgroundThere is controversy regarding optimal use of benzodiazepines during cardiac surgery, and it is unknown whether and to what extent there is variation in practice. We sought to describe benzodiazepine use and sources of variation during cardiac surgeries across patients, clinicians, and institutions.

methodsWe conducted an analysis of adult cardiac surgeries across a multicentre consortium of USA academic and private hospitals from 2014 to 2019. The primary outcome was administration of a benzodiazepine from 2 h before anaesthesia start until anaesthesia end. Institutional-, clinician-, and patient-level variables were analysed via multilevel mixed-effects models.

resultsOf 65 508 patients cared for by 825 anaesthesiology attending clinicians (consultants) at 33 institutions, 58 004 patients (88.5%) received benzodiazepines with a median midazolam-equivalent dose of 4.0 mg (inter-quartile range [IQR], 2.0-6.0 mg). Variation in benzodiazepine dosage administration was 54.7% attributable to institution, 14.7% to primary attending anaesthesiology clinician, and 30.5% to patient factors. The adjusted median odds ratio for two similar patients receiving a benzodiazepine was 2.68 between two randomly selected clinicians and 4.19 between two randomly selected institutions. Factors strongly associated (adjusted odds ratio, <0.75, or >1.25) with significantly decreased likelihoods of benzodiazepine administration included older age (>80 vs ≤50 yr; adjusted odds ratio=0.04; 95% CI, 0.04-0.05), university affiliation (0.08, 0.02-0.35), recent year of surgery (0.42, 0.37-0.49), and low clinician case volume (0.44, 0.25-0.75). Factors strongly associated with significantly increased likelihoods of benzodiazepine administration included cardiopulmonary bypass (2.26, 1.99-2.55), and drug use history (1.29, 1.02-1.65).

conclusionsTwo-thirds of the variation in benzodiazepine administration during cardiac surgery are associated with institutions and attending anaesthesiology clinicians (consultants). These data, showing wide variations in administration, suggest that rigorous research is needed to guide evidence-based and patient-centred benzodiazepine administration.

Indexed as

AnesthesiaCardiac Surgical ProceduresAdultBenzodiazepinesHumansMidazolamBenzodiazepinesMidazolamanaesthesiabenzodiazepinescardiac procedurescardiovascular surgeryphysicianspractice patterns

Identifiers

PMID35101244
PMCPMC9074791

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.