Impact of Intravenous Hydrocortisone on Postoperative Atrial Fibrillation and Outcomes in Patients Receiving Vasopressor Support Following On-Pump Coronary Artery Bypass Grafting

Background: Although 2019 EACTS Guidelines on Cardiopulmonary Bypass in Adult Cardiac Surgery recommend against routine use of prophylactic corticosteroids, perioperative glucocorticoids are still often used to mitigate hypotension, cardiac arrhythmias and respiratory failure following surgery with cardiopulmonary bypass (CPB). Limited data exists on safety and efficacy of intravenous (IV) hydrocortisone in this setting. Objectives: To assess the impact of intravenous hydrocortisone on postoperative complications after on-pump coronary artery bypass grafting (CABG). Methods: This was a single-center, retrospective chart review between 2021 and 2023. Adult patients with on-pump CABG requiring vasopressor therapy postoperatively were included. Results: Of 153 patients included, 39 received IV hydrocortisone and 114 did not. The hydrocortisone group had significantly lower cortisol levels (15.8 mcg/dL vs 23.9 mcg/dL, P < 0.001) and higher incidence of a past medical history of atrial fibrillation (23.1% vs 2.6%, P < 0.001) compared to the control group. Rates of postoperative atrial fibrillation (POAF) were similar between groups with 23.1% in the hydrocortisone group and 21.9% in the control group ( P = 0.88), which maintained after controlling for age, history of atrial fibrillation, sex, and propensity score ( P = 0.86). Mean cumulative norepinephrine equivalents (NEE) were similar between hydrocortisone group and control (10.4 mcg/min vs 8.9 mcg/min, P = 0.12). Hydrocortisone administration was associated with longer durations of vasopressor therapy (45.8 vs 28.9 hours, P = 0.001), insulin therapy (149.4 vs 82.2 hours, P = 0.003), and total mechanical ventilation time (59.3 vs 19.4 hours, P = 0.049). There were no differences in surgical site infections between the hydrocortisone group versus control group (5.2% vs 5.2%, P = 1.00), including both non-infectious (2.6% vs 2.6%, P = 1.00) and infectious surgical site complications (2.6% vs 2.6%, P = 1.00). Conclusion: After controlling for sex, age, history of atrial fibrillation/flutter, and propensity score, there was no significant association between the administration of IV hydrocortisone and POAF in patients receiving vasopressor support following on-pump CABG. Further prospective studies are needed to confirm these findings.