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Abstract

Introduction: Propofol (PROP) has been shown to reduce duration of mechanical ventilation (DMV) in patients undergoing coronary artery bypass grafting surgery (CABG) without increasing postoperative complications. Due to a nationwide shortage of PROP, utilization of alternative agents such as midazolam (MIDAZ) and dexmedetomidine (DEX) has been necessary. Drug costs favor use of MIDAZ, but based on its pharmacology, DEX may have better outcomes. Hypothesis: Use of DEX, as compared to PROP or MIDAZ, will decrease DMV, ICU length of stay (LOS), and postoperative LOS in patients undergoing elective, isolated CABG, with favorable economic outcomes. Methods: A retrospective cohort study of patients (pts) undergoing elective isolated CABG between January 2008-December 2011 at a single institution was performed. Pts were identified via a surgery database and MS-DRG codes and separated into 3 treatment groups based on sedative agent used immediately postoperatively. Pts were matched 1:1:1 based on age, sex, number of vessels, and bypass time. Results: Ninety patients were included, 42 pts each in the DEX and PROP groups and 6 in the MIDAZ group. Baseline demographics were similar between all groups. More pts in the DEX group were extubated?6h (p<0.001). Fewer pts in the DEX group required DMV? 24h (p=0.005). There was a trend towards ICU LOS?48h in the DEX group compared to PROP and MIDAZ groups, though not significant (p=0.06). More pts in the DEX group had postop hospital LOS?5d (p=0.01) and overall hospital LOS?7d (p<0.001). Average cost of drug therapy was greater in the DEX arm but was offset by savings in cost of room/board associated with a decrease in LOS: the per-patient total hospital room/board savings was $4,246 for choosing DEX versus PROP, and $9,988 for choosing DEX versus MIDAZ (p=0.035). Conclusions: DEX was shown to have significantly better outcomes with respect to DMV, ICU LOS, overall hospital LOS when analyzed based on significant time points, and is associated with significant cost savings. Randomized, controlled studies are needed to confirm these results.