Effect of dopexamine infusion on mortality following major surgery: individual patient data meta-regression analysis of published clinical trials.

OBJECTIVES: To establish whether perioperative low-dose dopexamine infusion (< or = 1 microg/kg/min) is associated with a reduction in mortality and duration of hospital stay following major surgery. DATA SOURCE: Medline, EMBASE, CINAHL, Cochrane Library, Google Scholar, and reference lists. STUDY SELECTION: Two reviewers independently screened studies for inclusion, assessed trial quality, and extracted data. Eligible trials were randomized controlled trials comparing dopexamine infusion to control treatment. Data are reported as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals. DATA EXTRACTION: Systematic review and meta-regression analysis of individual patient data. DATA SYNTHESIS: Five studies fulfilled the inclusion criteria. Analysis of pooled data from high- and low-dose dopexamine groups identified a reduction in duration of hospital stay (median 14 vs. 15 days; HR 0.85 [0.73-0.91]; p = .03) but no improvement in mortality (9.1% vs. 12.3%; OR 0.78 [0.31-1.99]; p = .61). However, low-dose dopexamine was associated with a 50% reduction in 28-day mortality (6.3% vs. 12.3%; OR 0.50 [0.28-0.88]; p = .016) as well as a reduced duration of stay (median 13 vs. 15 days; HR 0.75 [0.64-0.88]; p = .0005). When high-dose dopexamine groups were compared with controls, there was no difference in either mortality (OR 1.06 [0.60-1.87]; p = .85) or duration of stay (HR 1.04 [0.94-1.16]; p = .36).
CONCLUSIONS: For pooled data describing perioperative dopexamine infusion at all doses, there was an improvement in duration of hospital stay but no survival benefit. However, at low doses, dopexamine was associated with improved survival and reduced duration of stay. Further clinical trials are warranted to confirm this observation.