Perioperative dexmedetomidine improves outcomes of cardiac surgery

Abstract

Background: Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality after cardiac surgery.

Methods and results: A total of 1134 patients who underwent coronary artery bypass surgery and coronary artery bypass surgery plus valvular or other procedures were included. Of them, 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores, and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (stroke, coma, perioperative myocardial infarction, heart block, or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay, and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital (1.23% versus 4.59%; adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614; P<0.0001), 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95% confidence interval, 0.226-0.655; P<0.0001), and 1-year (3.17% versus 7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701; P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18% versus 54.06%; adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and delirium (5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75; P=0.0030).

Conclusion: Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.

Clinical trial registration: URL: www.clinicaltrials.gov. Unique identifier: NCT01683448.

Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

Figure 1

Study population recruitment summary.

Figure 2

Parsimonious multi variable propensity model for dexmedetomidine use. OR, odds ratio; CI, confidence interval; Family history of CAD, preoperative family history of coronary artery disease; PreOp CHF, preoperative congestive heart failure; CABG, coronary artery bypass graft; PreOp EF, preoperative ejection fraction.

Figure 3

Effects of dexmedetomidine on postoperative complications and mortality in patients undergoing cardiac surgery. Values are numbers (%) for categorical variables. OR, odds ratio; CI, confidence interval; MACE, major adverse cardiocerebral events; MI, myocardial infarction; RF, renal failure; DEX, dexmedetomidine. *Adjusted for propensity score, age, body mass index, diabetes, current smoking, surgical type, IABP use and family history of CAD before surgery. †Adjusted for propensity score, age, status of procedure, BMI, creatinine level, smoking, chronic lung disease, cerebrovascular disease, peripheral vascular disease, family history of CAD, diabetes, hypertension, renal failure, MI, CHF, IABP, beta blockers, angiotensin-converting enzyme inhibitors, anticoagulants, anti-platelet drugs, steroids, aspirin, surgical type, EF, perfusion time, and year of surgery.‡Adjusted for propensity score, age, smoking, diabetes and surgical type; §, Adjusted for propensity score, age, diabetes perfusion time, and year of surgery. ∥ Adjusted for propensity score, age, status of procedure, family history of CAD, diabetes, hypertension, surgical type and angiotensin-converting enzyme. # Adjusted for propensity score, age, status of procedure, family history of CAD, surgical type and perfusion time.

Figure 4

Survival estimates after cardiac surgery. Survival probabilities were calculated with the use of Kaplan–Meier methods and compared with the use of a log-rank test (Log -Rank test, chi-square=10.734, p=0.0011). The dash line represents the survival probabilities of individuals who received dexmedetomidine; the solid line represents the survival probabilities of individuals who did not. DEX, dexmedetomidine.

Figure 5

Cox proportional hazard model for 1-year mortality following cardiac surgery. OR, odds ratio; CI, confidence interval; CAD, coronary artery disease; CABG, coronary artery bypass graft.