Perioperative Dexmedetomidine and 30-Day Outcomes After Adult Cardiac Surgery

Perioperative Dexmedetomidine and 30-Day Outcomes After Adult Cardiac Surgery: A Real-World Retrospective Cohort Study Using the TriNetX Network

This observational study uses de-identified electronic health record data from the TriNetX Global Collaborative Network (2010-01-01 to 2025-07-01) to examine whether perioperative dexmedetomidine (DEX) is associated with 30-day outcomes after adult cardiac surgery. Adults aged 18-100 years undergoing first-time coronary artery bypass grafting or heart valve surgery are included. Exposure is any DEX administration from 24 hours before to 48 hours after the index operation; comparators receive no DEX in this window. The primary outcome is delirium within 30 days. Secondary outcomes are 30-day all-cause mortality, acute kidney injury, pneumonia, sepsis, red blood cell transfusion/major bleeding, myocardial infarction, ischemic stroke/transient ischemic attack, atrial fibrillation, mechanical ventilation >96 hours (days 4-30), and 30-day readmission (days 1-30). No treatments are assigned by investigators and no identifiable information is used. Findings aim to inform perioperative sedation strategies in routine cardiac surgery care.

Study Overview

• Status: Completed
• Conditions: Postoperative Complications; Valve Surgery; Cardiac Surgical Procedures; Delirium - Postoperative; Coronary Artery Bypass Graft (CABG)
• Intervention / Treatment: Drug: Dexmedetomidine; Other: Usual care without perioperative dexmedetomidine

Detailed Description

This is a retrospective cohort study using de-identified data from the TriNetX Global Collaborative Network (2010-01-01 to 2025-07-01). Adults aged 18-100 years undergoing first-time coronary artery bypass grafting or heart valve surgery will be identified. Perioperative exposure is defined as any dexmedetomidine administration from 24 hours before to 48 hours after the index surgery; the comparison cohort consists of patients without dexmedetomidine in this window. Clinical outcomes within 30 days after surgery include delirium as the primary outcome and a range of major postoperative complications and mortality. Propensity scores based on demographics, comorbidities, baseline medications and laboratory tests will be used to match or adjust between exposure groups, with balance assessed using standardized mean differences. Time-to-event analyses will use Cox proportional hazards models and Kaplan-Meier curves, with multiplicity controlled using the Benjamini-Hochberg false discovery rate. All analyses use only de-identified data within the TriNetX platform, with no direct contact with patients or access to identifiers.

• Study Type: Observational
• Enrollment (Actual): 408153

Contacts and Locations

Study Locations

• Taiwan
  • Taichung City
    • Taichung, Taichung City, Taiwan, 40447
      • China Medical University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18-100 years undergoing first-time CABG or valve surgery in the TriNetX Global Collaborative Network (2010-01-01 to 2025-07-01); de-identified EHR data; exposure defined as perioperative dexmedetomidine -24 to +48 h; comparator without dexmedetomidine in that window.

Description

Inclusion Criteria:

• Age 18-100 years.
• First-time CABG or heart valve surgery within TriNetX during 2010-01-01 to 2025-07-01.
• ≥90 days pre-operative observable data and a 30-day post-operative window (death ≤30 days counts as complete).
• Index surgery, exposure window (-24 to +48 h), and outcomes identifiable from standardized platform codes/fields.

Exclusion Criteria:

• End-stage renal disease or dialysis within 90 days before index surgery (ICD-10-CM N18.6, Z49, Z99.2).
• Not first-time CABG/valve in the same admission.
• Missing required fields or conflicting records preventing unique case definition.
• Unable to confirm exposure window or outcomes within the platform.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Perioperative Dexmedetomidine; Adults undergoing first-time CABG or valve surgery with any dexmedetomidine recorded from 24 h before to 48 h after the index surgery on TriNetX; exposure observed in routine care, not assigned by investigators.	Drug: Dexmedetomidine; Exposure in routine care within -24 to +48 hours of the index cardiac surgery; dose and regimen not protocol-assigned; observational only; exposure captured from medication records and used to define the dexmedetomidine cohort.; Other Names: Precedex
No Perioperative Dexmedetomidine; Same surgical cohort with no dexmedetomidine recorded within the -24 to +48 h window; use of dexmedetomidine outside this window allowed; comparison reflects perioperative sedation strategy.	Other: Usual care without perioperative dexmedetomidine; No dexmedetomidine administered within -24 to +48 hours of the index surgery; all other management per routine care; observational comparator; dexmedetomidine use outside this window permitted.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Delirium within 30 days	Delirium identified from EHR codes (ICD-10-CM/SNOMED CT). TriNetX "exclude prior to window" enabled; patients with delirium before Day 0 excluded from the risk set. Estimates reported as cumulative incidence and Cox HR with 95% CI.	Day 0 through Day 30 after index surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause mortality within 30 days	Death status from death registry/EHR status flags; exclude-prior-to-window enabled; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Acute kidney injury within 30 days	Acute kidney injury by ICD-10-CM/SNOMED CT codes; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Pneumonia within 30 days	Pneumonia by ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Sepsis within 30 days	Sepsis by ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Red blood cell transfusion or major haemorrhage within 30 days	Any red blood cell transfusion or major bleeding by CPT/HCPCS and ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Myocardial infarction within 30 days	Myocardial infarction by ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Ischemic stroke or transient ischemic attack within 30 days	Ischemic stroke/transient ischemic attack by ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Atrial fibrillation within 30 days	Atrial fibrillation by ICD-10-CM/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 0 through Day 30 after index surgery
Mechanical ventilation >96 hours	Duration of invasive mechanical ventilation >96 h using ICD-10-PCS/CPT/HCPCS/SNOMED CT; exclude-prior-to-window; cumulative incidence and Cox HR.	Day 4 through Day 30 after index surgery
30-day readmission	Any all-cause hospital readmission from encounter/admission flags (diagnoses on readmission as coded); exclude-prior-to-window; cumulative incidence and Cox HR.	Day 1 through Day 30 after index surgery

Collaborators and Investigators

• Sponsor: China Medical University Hospital
• Investigators: Principal Investigator: En-Bo Wu, MD, Department of Anesthesiology, China Medical University Hospital, Taichung City, Taiwan

Publications and helpful links

General Publications

• Poon WH, Ling RR, Yang IX, Luo H, Kofidis T, MacLaren G, Tham C, Teoh KLK, Ramanathan K. Dexmedetomidine for adult cardiac surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia. 2023 Mar;78(3):371-380. doi: 10.1111/anae.15947. Epub 2022 Dec 19.
• Caetano da Silva L, Tapioca V, Viana P, Pereira EM, Gibicoski T, Amaral S. Dexmedetomidine for delirium prevention after cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med. 2025 Sep;44(5):101578. doi: 10.1016/j.accpm.2025.101578. Epub 2025 Jun 24.
• Wang HB, Jia Y, Zhang CB, Zhang L, Li YN, Ding J, Wu X, Zhang Z, Wang JH, Wang Y, Yan FX, Yuan S, Sessler DI. A randomised controlled trial of dexmedetomidine for delirium in adults undergoing heart valve surgery. Anaesthesia. 2023 May;78(5):571-576. doi: 10.1111/anae.15983. Epub 2023 Feb 16.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2010
• Primary Completion (Actual): July 31, 2025
• Study Completion (Actual): July 31, 2025

Study Registration Dates

• First Submitted: November 17, 2025
• First Submitted That Met QC Criteria: November 24, 2025
• First Posted (Actual): November 25, 2025

Study Record Updates

• Last Update Posted (Actual): November 25, 2025
• Last Update Submitted That Met QC Criteria: November 24, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Perioperative Care; Cardiac Surgery; Dexmedetomidine; Propensity Score Matching; TriNetX
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Pathologic Processes; Confusion; Neurobehavioral Manifestations; Neurocognitive Disorders; Delirium; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Emergence Delirium; Postoperative Complications; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Azoles; Imidazoles; Dexmedetomidine
• Other Study ID Numbers: CMUH114-REC3-181

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: This retrospective observational study uses de-identified data from the TriNetX Global Collaborative Network. Investigators do not receive identifiable information or re-identification keys. The Data Use Agreement with TriNetX and participating health care organizations prohibits sharing or redistributing line-level individual participant data outside the platform. Only aggregate results and model estimates will be shared (e.g., tables, figures); study documents and analysis code may be provided on reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No