TheImpactoftheVEGA-1trialonlocalhospitalproviders’firstlinevasopressoruse

 

Background:

The VEGA-1 trial, a pilot cluster randomized crossover study that established feasibility of alarger trial involving norepinephrine (NE) or phenylephrine (PE) for hypotension, provides agood base to study long-term effects of a pragmatic trial on local anesthesia practice. TheVEGA-1trialranfromJuly-December2021andshowedthatNEwassafewithnodifferenceinpostoperative outcomes. Before VEGA-1, PE was the most predominantly used vasopressor formajornon-cardiac surgeries atUCSF.

 

Hypothesis:

WehypothesizedthattheVEGA-1trialincreasedNEuseinmajorsurgeryatUCSF.

 

Aims:

WeaimedtodetermineiftheVEGA-1trialchangedlocalpracticeandestablishedequipoisebetween NE and PE as first-line vasopressor infusions.

 

Methods

This was a retrospective cohort study at three UCSF hospitals from January 2021-May 2023.Data from non-UCSF hospitals participating in VEGA-1 was not available. Time period A wasdefined as the 6 continuous months before VEGA-1. Period B was defined as the 6 months afterVEGA-1. The proportion of eligible cases (adults ≥ 18, inpatient admission, and majorsurgery>2hours under GA with cardiac, transplant, and obstetric surgeries excluded) receivingNE as 1st-line vasopressor outside of VEGA-1 was the primary outcome. Deidentified patientdata including surgery type, service, medical history, intraoperative medications, and laboratoryvalues was extracted from the electronic record. The primary outcome was compared for PeriodA and B using Chi-square. Interrupted time-series analysis was used to compare trends beforeand after VEGA-1. Statistical analyses were run in Stata.

 

Results

5933 cases were analyzed, with 11.6% NE use in Period A and 26.9% NE use in Period B. TheproportionofNEusedifferedbyperiod,p<.0001.BaselineNEusewas11%anddidnotchangesignificantly during Period A (slope = 0%/month, 95%CI, -0.2-0.6). At the start of Period B,there was an immediate 11.1% (95% CI, 7.8 to 14.6) increase in NE use. After VEGA-1, NE useincreased linearly by 1.5%/month [95%CI, 1.1-1.8). As of the most recent follow up, 17 monthsafter VEGA-1, the strong linear trend continued with no plateau in NE use.

 

Conclusions