Key result
Oral vitamin C fails to reduce postoperative medication costs vs placebo after cardiac surgery.
Why the study?
Vitamin C might prevent postoperative atrial fibrillation after cardiac surgery, but whether perioperative supplementation reduces in-hospital postoperative medication costs was unclear.
Does perioperative oral vitamin C supplementation reduce in-hospital postoperative medication costs in patients undergoing CABG or valve surgery?
RCT (n=253)
Double-blind
Computer-generated random number sequence
No
Does perioperative oral vitamin C supplementation reduce in-hospital postoperative medication costs in patients undergoing CABG or valve surgery?
Effect estimate: Cost ratio 0.90 (95% CI 0.77-1.06)
Absolute Event Rate: 264.6% vs 294.9%
p-value: p=0.31
Perioperative oral vitamin C supplementation does not reduce short-term postoperative medication costs, length of stay, or the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery.
No justification for perioperative vitamin C to reduce medication costs after cardiac surgery; confirms null effects on costs, LOS, and POAF.
BACKGROUND: Due to its antioxidant properties, vitamin C might be a promising and effective strategy for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. This study was aimed at evaluating whether vitamin C supplementation is effective in reducing the cost of in-hospital postoperative medication used for patients undergoing coronary artery bypass (CABG) or valve surgery (±CABG). OBJECTIVE: The primary goal of this study was to evaluate the impact of perioperative vitamin C supplementation in patients undergoing cardiac surgery on in-hospital postoperative medication costs, while secondary endpoints were the effects on length of stay (LOS) in both the intensive care unit (ICU) and the hospital, and the incidence of POAF. MATERIAL AND METHODS: From November 2018 to January 2021, 253 patients planned for CABG or valve surgery (±CABG) in AZ Maria Middelares, Ghent, Belgium, and who met the inclusion criteria (≥18 years of age, all having cardiac sinus rhythm, and who provided written informed consent) were randomised into a placebo group or vitamin C group. The medication was administered orally (1 g twice daily), starting from 5 days preoperatively until 10 days postoperatively. The medication used, LOS in the hospital/ICU, and development of clinically relevant POAF in the ICU were registered. RESULTS: Mean medication costs were €264.6 ± 98.1 for patients in the vitamin C group and €294.9 ± 267.3 for patients in the placebo group. When stratifying according to the type of surgery (CABG or valve surgery [±CABG]), these costs did not significantly differ. There was no significant difference in LOS or the incidence of clinically relevant POAF. CONCLUSION: Our data did not identify any short-term financial impact on postoperative medication costs after oral perioperative vitamin C supplementation (1 g twice daily) for patients undergoing a CABG procedure or valve surgery (±CABG). No effect was found on the LOS or the incidence of clinically relevant POAF. Potential effects in the longer term, after intravenous administration of vitamin C or in other types of (cardiac) surgery, are still to be investigated. CLINICAL TRIALS REGISTRATION NUMBER: NCT03592680.
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Heerman et al. (2023) conducted an RCT in Cardiac surgery (CABG or valve surgery) (n=253). Oral Vitamin C vs. Placebo was evaluated on In-hospital postoperative medication costs (Cost ratio 0.90, 95% CI 0.77-1.06, p=0.31). Oral vitamin C supplementation did not significantly reduce in-hospital postoperative medication costs compared to placebo in patients undergoing cardiac surgery (cost ratio 0.90).
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