Norepinephrine versus dopamine postoperatively in patients who underwent noncardiac surgery: A propensity-matched analysis using a nationwide intensive care database.

BACKGROUND: Catecholamine choices, such as norepinephrine and dopamine, for perioperative blood pressure control are essential for anesthesiologists and intensivists. However, studies in noncardiac surgery are limited. Therefore, we aimed to evaluate the effect of postoperative norepinephrine and dopamine on clinical outcomes in adult patients who underwent noncardiac surgery by analyzing a nationwide intensive care patient database.

METHODS: This study was a multicenter retrospective study using the Japanese Intensive care PAtient Database (JIPAD). Adult patients from the JIPAD who received norepinephrine or dopamine within 24 hours after noncardiac surgery between 2018 and 2020 were included. We compared the norepinephrine and dopamine groups using one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, length of hospital stay, and length of ICU stay.

RESULTS: The 6236 eligible patients from 69 ICUs were allocated to the norepinephrine group (n = 4652) or the dopamine group (n = 1584). Propensity score matching created a matched cohort of 1230 pairs. After propensity score matching, in-hospital mortality did not differ between the two groups (risk difference, 0.41%; 95% confidence interval, -1.15 to 1.96; p = 0.61). Among the secondary outcomes, only the length of ICU stay was significantly shorter in the norepinephrine group than that in the dopamine group (median length, 3 days versus 4 days, respectively; p < 0.001).

CONCLUSIONS: Norepinephrine in adult patients after noncardiac surgery was not associated with decreased mortality but was associated with a shorter length of ICU stay compared with dopamine.