The Effect of Dexmedetomidine on Outcomes of Cardiac Surgery in Elderly Patients

Abstract

Objective: The goal of this retrospective study was to investigate the effects of perioperative use of dexmedetomidine (Dex) on outcomes for older patients undergoing cardiac surgery.

Design: Retrospective investigation.

Setting: Patients from a single tertiary medical center.

Participants: A total of 505 patients (≥65 years old) who underwent coronary artery bypass graft (CABG) or valve surgery. CABG and/or valve surgery plus other procedures were divided into 2 groups: 283 received intravenous Dex infusion (Dex group) and 222 did not (Non-Dex group).

Interventions: Perioperative Dex intravenous infusion (0.24 to 0.6 μg/kg/h) initiated after cardiopulmonary bypass and continued for<24 hours postoperatively in the ICU.

Measurements and main results: Data were risk adjusted, propensity score weighted, and multivariate logistic regression was used. The primary outcome was mortality. Secondary outcomes included postoperative stroke, coma, myocardial infarction, heart block, cardiac arrest, delirium, renal failure, and sepsis. Perioperative Dex infusion significantly decreased in-hospital mortality (0.90% v 2.83%; adjusted odds ratio (OR), 0.099; 95% confidence interval (CI), 0.030-0.324; p = 0.004) and operative mortality (1.35% v 3.18%; adjusted OR, 0.251; 95% CI, 0.077-0.813; p = 0.021). Perioperative Dex treatment also reduced the risk of stroke (0.90% v 1.77%; adjusted OR, 0.15; 95% CI, 0.038-0.590; p = 0.007), and delirium (7.21% v 10.95%; adjusted OR, 0.35; 95% CI, 0.212-0.578; p < 0.0001).

Conclusions: Results from this study (ClinicalTrials.gov identifier: NCT01683448) suggested perioperative use of dexmedetomidine was associated with decreases in in-hospital and operative mortality in elderly patients following cardiac surgery. It also reduced incidences of postoperative stroke and delirium in elderly patients.

Keywords: dexmedetomidine; elderly cardiac surgery; hospital mortality; outcome operative mortality.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Study population recruitment summary. Dex: dexmedetomidine; CABG: coronary artery bypass graft

Figure 2

Represented the Parsimonious multivariable propensity model for dexmedetomidine use. CABG: coronary artery bypass graft; CVD: Cerebrovascular Disease; CAD: coronary artery disease; CHF: congestive heart failure; CI: confidence interval; EF: ejection fraction; and OR: odds ratio.

Figure 3

Showed the effects of dexmedetomidine on postoperative complications and mortality in patients undergoing cardiac surgery. Values are numbers (percent) for categorical variables. CI: confidence interval; Dex: dexmedetomidine; MI: myocardial infarction; and OR: odds ratio.

Figure 4

Demonstrated the Cox proportional hazard model for 1-year mortality after cardiac surgery in elderly patients. CABG: coronary artery bypass graft; IABP: Intra-aortic balloon pump; and CI: confidence interval.