Shifting Standards -- Uncovering Opioid Practice Patterns in Cardiac Surgery

Background: Cardiac anesthesia has traditionally relied on high doses of opioids to maintain hemodynamic stability during surgery. However, emerging practices now explore the use of lower-dose and multimodal analgesic strategies. While these alternatives are gaining attention, the actual variability in opioid use and its driving factors have remained unclear across institutions and providers. Objective: To quantify intraoperative opioid usage during cardiac surgery and to identify whether variation in opioid dosing is primarily influenced by patient factors, anesthesiologists, or institutional practices. Design: Observational cohort study. Methods: The authors analyzed data of adult patients undergoing nonemergent, on-pump cardiac surgeries across 30 academic and community hospitals between 2014 and 2021. Data were drawn from the Multicenter Perioperative Outcomes Group registry, encompassing 59,463 surgical cases managed by 794 anesthesiologists. Researchers measured intraoperative more...