Perioperative Dexmedetomidin und 30-Tage-Ergebnisse nach Herzchirurgie bei Erwachsenen
Perioperatives Dexmedetomidin und 30-Tage-Ergebnisse nach Herzchirurgie bei Erwachsenen: Eine retrospektive Kohortenstudie unter realen Bedingungen unter Verwendung des TriNetX-Netzwerks
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Studientyp
Studientyp
Einschreibung (Tatsächlich)
Einschreibung
Kontakte und Standorte
Studienorte
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Taichung City
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Taichung, Taichung City, Taiwan, 40447
- China Medical University Hospital
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Probenahmeverfahren
Studienpopulation
Beschreibung
Einschlusskriterien:
- Alter 18-100 Jahre.
- Erstmalige CABG oder Herzklappenoperation innerhalb von TriNetX während 2010-01-01 bis 2025-07-01.
- ≥90 Tage präoperative beobachtbare Daten und ein 30-tägiges postoperatives Fenster (Tod ≤30 Tage zählt als vollständig).
- Indexoperation, Expositionsfenster (-24 bis +48 h) und Ergebnisse identifizierbar aus standardisierten Plattformcodes/-feldern.
Ausschlusskriterien:
- Terminale Nierenerkrankung oder Dialyse innerhalb von 90 Tagen vor der Indexoperation (ICD-10-CM N18.6, Z49, Z99.2).
- Nicht erstmalige CABG/Klappe im gleichen Aufenthalt.
- Fehlende erforderliche Felder oder widersprüchliche Datensätze, die eine eindeutige Falldefinition verhindern.
- Expositionsfenster oder Ergebnisse innerhalb der Plattform nicht bestätigbar.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
Anzahl der Gruppen / Kohorten
Kohorten und Interventionen
Gruppe / KohorteGruppe / Kohorte |
Intervention / BehandlungIntervention / Behandlung |
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Dexmedetomidine medication record present
Eligible patients with a qualifying CABG-coded procedure and any RxNorm 48937 dexmedetomidine medication record on the preceding calendar day or the procedure day (days -1 through 0).
The same medication-record definition is used in the separately constructed exploratory valve-coded population relative to its own qualifying procedure.
Exposure is observed in routine records and is not assigned by investigators.
Administration, dose and intraday timing are not confirmed.
The CABG-coded and valve-coded populations may overlap and are reported separately.
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An observed dexmedetomidine medication record (RxNorm 48937) on the calendar day before or the day of the index procedure.
No drug, dose, route or regimen is assigned by the study.
This entry describes the record used for exposure classification, not a study intervention.
Andere Namen:
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Dexmedetomidine medication record absent
The corresponding eligible CABG-coded or separately constructed valve-coded population with no RxNorm 48937 dexmedetomidine medication record during days -1 through 0 relative to its qualifying index procedure.
Dexmedetomidine records outside this window, including later postoperative use, are permitted.
Absence of a record does not establish non-administration or identify an alternative sedative regimen.
The two procedure populations have separate eligibility and matching and may contain overlapping patients.
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Absence of a dexmedetomidine medication record during days -1 through 0 relative to the index procedure.
Other care is not assigned or standardised by the investigators.
Dexmedetomidine records outside the specified window are allowed.
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Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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First recorded code-defined delirium or disorientation during days 1-30 after the index procedure
Zeitfenster: Day 1 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM R41.0 or F05 record within the window.
R41.0 includes disorientation; this is a code-defined outcome without bedside delirium assessment or individual adjudication.
The CABG-coded population is primary and the valve-coded population exploratory.
Patients with either code on or before day 0 in all available history are excluded before matching.
The outcome-level prior-window exclusion is OFF.
Analysis uses the two-sided log-rank test, Kaplan-Meier window-end failure estimates and complementary hazard ratios, subject to the documented censoring and proportionality limitations.
The day-1 start is not a verified survival landmark.
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Day 1 through Day 30 after the index procedure
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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All-cause mortality during days 0-30 after the index procedure
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to a dated death record using the TriNetX Deceased outcome.
Death is the event for this endpoint.
The data are not assumed to constitute a complete national death registry.
Outcome-level prior-window exclusion is OFF.
This is one of the eight inferential secondary endpoints in the CABG population.
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Day 0 through Day 30 after the index procedure
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Code-defined acute kidney injury during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM N17 record, including applicable descendant codes, within the window.
No endpoint-specific exclusion of prior N17 records is applied; this describes a recorded outcome, not necessarily newly occurring disease.
Dialysis codes are not treated as acute kidney injury.
This replaces the earlier acute-kidney-injury/dialysis composite and is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Code-defined pneumonia during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying record of ICD-10-CM J13, J14, J15, J16, J17 or J18, or ICD-9-CM 483, within the window.
No endpoint-specific exclusion of prior pneumonia records is applied.
The outcome does not establish microbiological confirmation or newly occurring disease.
This is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Code-defined sepsis during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM A40 or A41 record within the window.
No endpoint-specific exclusion of prior sepsis records is applied.
This is a recorded-code outcome, not necessarily newly occurring sepsis, and is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Blood transfusion, haemorrhage-related diagnosis or thoracic exploration code during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Any qualifying ICD-10-CM I97.410, I97.411, I97.610, I97.611 or D62 record, or SNOMED CT 116863004, 288170000, 301842006, 175190002, 26337002 or 77202008 record, during the analysis window, without endpoint-specific exclusion of prior qualifying records.
The retained components include blood transfusion, haemorrhage-related diagnoses and thoracic, pericardial or mediastinal exploration.
Exploration codes do not establish bleeding, a postoperative indication or re-operation.
This heterogeneous code-defined composite is not major bleeding and does not establish an adjudicated bleeding severity grade.
CPT 35820 is not included.
This is one of the eight inferential secondary endpoints in the primary CABG comparison.
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Day 0 through Day 30 after the index procedure
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Code-defined myocardial infarction during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM I21 or I22 record within the window.
No endpoint-specific exclusion of prior myocardial infarction records is applied.
This is a recorded-code outcome, not necessarily a new myocardial infarction, and is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Code-defined ischaemic stroke or transient ischaemic attack during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM I63 or G45 record within the window.
No endpoint-specific exclusion of prior stroke or transient ischaemic attack records is applied.
This is a recorded-code outcome, not necessarily newly occurring disease, and is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Code-defined atrial fibrillation during days 0-30
Zeitfenster: Day 0 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM I48.0, I48.1 or I48.91 record within the window.
No endpoint-specific exclusion of prior atrial fibrillation records is applied.
The definition is limited to this specified code set and does not establish new-onset atrial fibrillation.
This is one of the eight inferential secondary endpoints.
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Day 0 through Day 30 after the index procedure
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Proportion of patients with respiratory ventilation coded as greater than 96 consecutive hours
Zeitfenster: Day 0 through Day 30 after the index procedure
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Number and proportion of patients with at least one ICD-10-PCS 5A1955Z record during days 0-30.
The code denotes respiratory ventilation greater than 96 consecutive hours, but its recorded date does not establish intubation onset or when 96 hours was reached.
This explicitly replaces the previously registered days 4-30 window.
Use this outcome batch's analysed denominator; prior-window exclusion is OFF.
This is a descriptive recorded-code proportion, not a censoring-adjusted risk.
No ventilation Kaplan-Meier or Cox analysis is performed.
Comparative statistics generated automatically with the native patient-count output are preserved but are not interpreted as inferential study results or included in multiplicity adjustment.
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Day 0 through Day 30 after the index procedure
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Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Proportion of patients with a recorded inpatient or observation encounter during days 1-30
Zeitfenster: Day 1 through Day 30 after the index procedure
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Number and proportion of patients with at least one inpatient encounter flag (HL7 v3 Visit Type IMP) or a record under CPT grouping 1013659, Hospital Inpatient and Observation Care Services, within the window.
Discharge followed by a new admission is not required, so this replaces the earlier readmission label.
Use this measure's own batch denominator; prior-encounter exclusion is OFF.
Count patients, not encounter instances.
Automatically generated comparative statistics are preserved as technical outputs but are not interpreted as inferential results or included in multiplicity adjustment.
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Day 1 through Day 30 after the index procedure
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F05-only recorded delirium during days 1-30: sensitivity analysis
Zeitfenster: Day 1 through Day 30 after the index procedure
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Time to the first qualifying ICD-10-CM F05 record within the window, as an exploratory sensitivity analysis of the primary R41.0-or-F05 definition.
Retain the broader exclusion of any R41.0 or F05 record on or before day 0 in all available history, applied before matching.
Outcome-level prior-window exclusion is OFF.
The CABG sensitivity endpoint was specified and run alongside the revised primary endpoint on 5 September 2026.
It is outside the eight-test secondary multiplicity family; its addition to this registry amendment does not imply prospective registration of that run.
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Day 1 through Day 30 after the index procedure
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: En-Bo Wu, MD, Department of Anesthesiology, China Medical University Hospital, Taichung City, Taiwan
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- 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.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Tatsächlich)
Primärer Abschluss
Studienabschluss (Tatsächlich)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Neurologische Manifestationen
- Erkrankungen des Nervensystems
- Psychische Störungen
- Pathologische Prozesse
- Verwirrtheit
- Neurobehaviorale Manifestationen
- Neurokognitive Störungen
- Pathologische Zustände, Anzeichen und Symptome
- Anzeichen und Symptome
- Delirium
- Postoperative Komplikationen
- Heterocyclische Verbindungen, 1-Ring
- Heterocyclische Verbindungen
- Azolen
- Imidazoles
- Dexmedetomidin
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- CMUH114-REC3-181
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Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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