Early Vasoactive-Inotropic Score Trajectory as a Marker of Postoperative Recovery After Major Cardiac Surgery: An Exploratory Cohort Study

Background and Objectives: The vasoactive-inotropic score (VIS) is associated with adverse outcomes after cardiac surgery, but most studies have evaluated a single VIS value. We aimed to describe early VIS patterns across three perioperative time points and their concurrent association with early postoperative complications (EPC). Materials and Methods: In this exploratory, retrospective, single-center cohort, 90 of 93 adults in a database of patients undergoing major cardiac surgery were analyzed (three were excluded for incomplete VIS data). Peak VIS was recorded intraoperatively, on the day of surgery (Z0), and on postoperative day 1 (Z1). Using a threshold of VIS ≥5, patients were classified as minimal support, rapid responders, persistent vasoactive support, or delayed deterioration (non-elevated intraoperative VIS with VIS ≥5 at Z1). Analyses were descriptive and unadjusted; categorical variables were compared with exact tests. Results: The four groups comprised 57, 7, 18, and 8 patients, respectively. Cardiopulmonary bypass and aortic cross-clamp times differed across groups (p = 0.010 and p = 0.005). EPC occurred in 36 patients (40.0%): in 28%, 43%, 56%, and 88% of the four groups, respectively (p = 0.004). Compared with minimal support, crude odds ratios for EPC were 3.15 (95% CI 0.93–11.08) for persistent vasoactive support and 17.11 (95% CI 1.96–827.40) for delayed deterioration; for rapid responders, no association was demonstrable. No between-group difference in stroke was demonstrable (two events; p = 0.132). Conclusions: In this small exploratory cohort, early VIS patterns, particularly support emerging after a non-elevated intraoperative VIS, were concurrently associated with a more complicated early postoperative course. Because complications may have preceded or coincided with VIS assessment and the estimates were unadjusted and imprecise, these patterns should not be interpreted as predictors.