Intraoperative corticosteroid administration and postoperative pulmonary complications: a secondary analysis of the iPROVE clinical trials

BACKGROUND This study aimed to explore the effect of intraoperative corticosteroid administration at antiemetic doses on postoperative pulmonary complications in adult patients undergoing major surgery. METHODS We designed a post hoc analysis of two clinical trials conducted across 30 hospitals that included adult patients undergoing major abdominal or thoracic surgeries. Patients who received intraoperative corticosteroids were identified and balanced with those who did not receive corticosteroids using inverse probability of treatment weighting based on preoperative confounders. The primary outcome was a composite of postoperative pulmonary complications within 30 days after surgery. Generalised mixed-effects models with random intercepts at each hospital were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of 1963 patients were included. Before weighting for potential confounders, the incidence of severe postoperative pulmonary complications was lower in those who received corticosteroids than those who did not (9.3% [107/1142] vs 14.0% [113/821], P=0.002). After weighting, intraoperative corticosteroids were not associated with a significant reduction in the incidence of postoperative pulmonary complications (OR 0.86, 95% CI 0.62-1.18, P=0.347), but there was a modest improvement in partial pressure of oxygen in arterial blood-to-fraction of inspired oxygen ratios in the PACU in those who received intraoperative corticosteroids compared with those who did not (adjusted mean difference 19.9 mm Hg, 95% CI 0.64-39.1, corrected P=0.043). CONCLUSIONS Corticosteroid administration at antiemetic doses in adult patients having major abdominal or thoracic surgery was not associated with a lower incidence of postoperative pulmonary complications. Postoperative pulmonary gas exchange marginally improved in patients receiving intraoperative corticosteroids. CLINICAL TRIAL REGISTRATION NCT03182062 and NCT02798133.