Key result
Prophylactic dexamethasone during adult cardiac surgery was associated with a reduced risk of the composite clinical outcome (OR 0.82; 95% CI 0.72-0.92; P<0.001).
Why the study?
Prophylactic steroids may reduce morbidity and mortality by modulating the inflammatory response in cardiac surgery, but real-world clinical outcomes and practice variation needed evaluation.
Does perioperative dexamethasone reduce 30-day mortality and composite adverse outcomes in patients undergoing elective and urgent on-pump cardiac surgery?
Cohort (n=54,694)
Yes
Does perioperative dexamethasone reduce 30-day mortality and composite adverse outcomes in patients undergoing elective and urgent on-pump cardiac surgery?
Prophylactic dexamethasone during on-pump cardiac surgery is associated with reduced composite adverse outcomes and shorter hospital stays, but may increase 30-day mortality in patients over 80 years old.
Answers are grounded in this paper and cite their sources.
Perioperative dexamethasone may improve cardiac surgery outcomes; leaves open need for randomized confirmation before practice change.
BACKGROUND: In cardiac surgery, modulating the inflammatory response with prophylactic steroids may reduce morbidity and mortality. We aimed to evaluate the association of dexamethasone use with clinical outcomes and its variation in clinical practice in a real-world setting. METHODS: This retrospective, population-based study evaluated data of elective and urgent to on-pump cardiac surgery patients from the Netherlands Heart Registration between 2013 and 2021. Patients who received perioperative dexamethasone were compared to those who did not. The primary outcomes were 30-day mortality and a composite of 30-day mortality, in-hospital stroke, and 30-day renal or respiratory failure. Secondary outcomes included the individual components of the composite outcome, a composite of infection-related outcomes, arrhythmias, and length of hospital stay. Propensity score matching was applied to adjust for confounders. Clinical practice variation was assessed through a national survey of Dutch cardiac anesthesiologists. RESULTS: In the study, 54,694 patients were included, with 40,891 patients (74.8%) receiving dexamethasone. After propensity score matching, dexamethasone use was associated with a lower risk of the composite clinical outcome (odds ratio [OR] 0.82, 95% confidence interval [CI], 0.72-0.92, P < .001), with a significant reduction in renal failure (OR 0.57, 95% CI, 0.47-0.70, P < .001). The length of hospital stay was significantly shorter (B -0.17, 95% CI, -0.32 to -0.02, P = .025). Other individual components of the composite outcome and secondary outcomes did not show a significant association with dexamethasone use. However, in patients >80 years, dexamethasone use was associated with increased 30-day mortality (OR 1.52, 95% CI, 1.01-2.28, P = .044). The observed benefits were consistent across other demographic and clinical subgroups. The survey indicated substantial variability in dexamethasone use across centers and anesthesiologists. CONCLUSIONS: Prophylactic dexamethasone during adult cardiac surgery was associated with reduced composite clinical outcomes, renal failure, and shorter hospital stays, and seemed associated with 30-day mortality in patients >80 years old.
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Steenbergen et al. (2025) conducted a cohort in Cardiac surgery (n=54,694). Dexamethasone vs. No dexamethasone was evaluated on Composite of 30-day mortality, in-hospital stroke, and 30-day renal or respiratory failure (OR 0.82, 95% CI 0.72-0.92, p=< .001). Prophylactic dexamethasone during adult cardiac surgery was associated with a reduced risk of the composite clinical outcome (OR 0.82; 95% CI 0.72-0.92; P<0.001).
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