Development and validation of the Scholarship of Teaching and Learning Assessment Questionnaire (SoTLAQ) among health professions educators.

Cardiac surgery is a frequently performed major surgical procedure worldwide, and effective postoperative pain management constitutes a critical element of perioperative care [–]. Adequate analgesia plays a pivotal role in facilitating patient recovery, minimizing postoperative complications, and optimizing healthcare resource utilization, including reducing the length of hospital stay (LOS) []. Hypertension is among the most prevalent comorbidities in patients undergoing cardiac surgery [–], with many requiring ongoing antihypertensive therapy. Calcium channel blockers (CCB), as first-line agents for hypertension management, are commonly continued throughout the perioperative period []. Concurrently, opioids remain the standard of care for managing moderate to severe postoperative pain due to their potent analgesic efficacy []. Consequently, the concomitant use of CCB and opioids in hypertensive patients undergoing cardiac surgery represents a common yet complex clinical scenario that may predispose patients to potential drug–drug interactions (DDIs). Pharmacologically, CCB—particularly dihydropyridine derivatives—are recognized inhibitors of cytochrome P450 3A4 (CYP3A4) []. Importantly, several widely used opioids, including fentanyl and oxycodone, are predominantly metabolized via the CYP3A4 pathway [–]. The co-administration of CYP3A4-inhibiting CCB with these opioids may theoretically impair opioid metabolism, resulting in elevated systemic drug concentrations and an increased risk of adverse effects such as excessive sedation and respiratory depression [, ]. These adverse events may contribute to organ dysfunction and potentially prolong hospitalization. Despite this mechanistic plausibility, the real-world clinical impact of this interaction on key patient outcomes—particularly LOS—remains inadequately characterized. Furthermore, significant inter-agent variability exists in opioid metabolic pathways; for instance, morphine and hydromorphone are primarily metabolized through glucuronidation, a process largely independent of CYP3A4 activity []. This pharmacokinetic distinction suggests that the magnitude and clinical consequences of CCB-opioids interactions may differ substantially across opioid classes. To date, there is a paucity of direct comparative studies examining such differential effects, representing a critical knowledge gap. Elucidating drug-specific interactions is essential for informing evidence-based analgesic selection, improving patient safety, and enhancing overall perioperative care efficiency. Accordingly, this study aims to leverage a large-scale intensive care database to investigate, for the first time, the differential effect of combining CCB with various opioid classes—including fentanyl, hydromorphone, morphine, oxycodone, and tramadol—on LOS in hypertensive patients undergoing cardiac surgery. We hypothesize that, compared to opioids with minimal reliance on CYP3A4 metabolism (e.g., hydromorphone), those primarily metabolized by CYP3A4 (e.g., fentanyl and oxycodone) will be associated with prolonged hospital stays when used concomitantly with CCB.