Dirk van Osch1, Jan M Dieleman2, Hendrik M Nathoe3, Marc P Boasson2, Jolanda Kluin4, Jeroen J H Bunge3, Arno P Nierich5, Peter M Rosseel6, Joost M van der Maaten7, Jan Hofland8, Jan C Diephuis9, Fellery de Lange10, Christa Boer11, Diederik van Dijk2. 1. Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: d.vanosch@umcutrecht.nl. 2. Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands. 3. Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands. 4. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 5. Department of Anesthesiology and Intensive Care, Isala Klinieken, Zwolle, Netherlands. 6. Department of Anesthesiology and Intensive Care, Amphia Ziekenhuis, Breda, Netherlands. 7. Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands. 8. Department of Anesthesiology and Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands. 9. Department of Anesthesiology and Intensive Care, Medisch Spectrum Twente, Enschede, Netherlands. 10. Department of Anesthesiology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands. 11. Department of Anesthesiology, Vrije Universiteit Medisch Centrum, Amsterdam, Netherlands.
Abstract
BACKGROUND: Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficial effect of dexamethasone on major adverse events in cardiac surgical patients. Previous studies suggest that corticosteroids may affect postoperative coagulation and blood loss, and therefore could influence the risk of surgical reinterventions. We investigated the effects of prophylactic intraoperative dexamethasone treatment on the rate of rethoracotomyafter cardiac surgery. METHODS: We performed a post-hoc additional data collection and analysis in the DECS trial. A total of 4,494 adult patients undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to intravenous dexamethasone (1.0 mg/kg) or placebo. The primary endpoint for the present study was the incidence of any rethoracotomy within the first 30 postoperative days. Secondary endpoints included the reason for rethoracotomy and the incidence of perioperative transfusion of blood products. RESULTS: In the dexamethasone group, 217 patients (9.7%) underwent a rethoracotomy, and in the placebo group, 165 patients did (7.3%; relative risk 1.32, 95% confidence interval: 1.09 to 1.61, p = 0.005). The most common reason for rethoracotomy was tamponade in both groups: 3.9% versus 2.1%, respectively (relative risk 1.84, 95% confidence interval: 1.30 to 2.61, p < 0.001). CONCLUSIONS:Intraoperative high-dose dexamethasone administration in cardiac surgery was associated with an increased rethoracotomy risk.
RCT Entities:
BACKGROUND: Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficial effect of dexamethasone on major adverse events in cardiac surgical patients. Previous studies suggest that corticosteroids may affect postoperative coagulation and blood loss, and therefore could influence the risk of surgical reinterventions. We investigated the effects of prophylactic intraoperative dexamethasone treatment on the rate of rethoracotomy after cardiac surgery. METHODS: We performed a post-hoc additional data collection and analysis in the DECS trial. A total of 4,494 adult patients undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to intravenous dexamethasone (1.0 mg/kg) or placebo. The primary endpoint for the present study was the incidence of any rethoracotomy within the first 30 postoperative days. Secondary endpoints included the reason for rethoracotomy and the incidence of perioperative transfusion of blood products. RESULTS: In the dexamethasone group, 217 patients (9.7%) underwent a rethoracotomy, and in the placebo group, 165 patients did (7.3%; relative risk 1.32, 95% confidence interval: 1.09 to 1.61, p = 0.005). The most common reason for rethoracotomy was tamponade in both groups: 3.9% versus 2.1%, respectively (relative risk 1.84, 95% confidence interval: 1.30 to 2.61, p < 0.001). CONCLUSIONS: Intraoperative high-dose dexamethasone administration in cardiac surgery was associated with an increased rethoracotomy risk.