Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery

Abstract

Objective: This study retrospectively investigated the effect of dexmedetomidine on outcomes of patients undergoing coronary artery bypass graft (CABG) surgery.

Design: Retrospective investigation.

Setting: Patients from a single tertiary medical center.

Participants: A total of 724 patients undergoing CABG surgery met the inclusion criteria and were categorized into 2 groups: 345 in the dexmedetomidine group (DEX) and 379 in the nondexmedetomidine group (Non-DEX).

Interventions: Perioperative dexmedetomidine was used as an intravenous infusion (0.24 to 0.6 µg/kg/hour) initiated after cardiopulmonary bypass and continued for less than 24 hours postoperatively in the intensive care unit.

Measurements and main results: Major outcome measures of this study were in-hospital, 30-day and 1-year all-cause mortality, delirium and major adverse cardiocerebral events. Perioperative dexmedetomidine infusion was associated with significant reductions in in-hospital, 30-day, and 1-year mortalities, compared with the patients who did not received dexmedetomidine. In-hospital, 30-day, and 1-year mortalities were 1.5% and 4.0% (adjusted odds ratio [OR], 0.332; 95% CI, 0.155 to 0.708; p = 0.0044), 2.0% and 4.5% (adjusted OR, 0.487; 95% CI, 0.253 to 0.985; p = 0.0305), and 3.2% and 6.9% (adjusted OR 0.421; 95% CI, 0.247 to 0.718, p = 0.0015), respectively. Perioperative dexmedetomidine infusion was associated with a reduced risk of delirium from 7.9% to 4.6% (adjusted OR, 0.431; 95% CI, 0.265-0.701; p = 0.0007).

Conclusion: Dexmedetomidine infusion during CABG surgery was more likely to achieve improved in-hospital, 30-day, and 1-year survival rates, and a significantly lower incidence of delirium.

Keywords: coronary artery bypass graft; delirium; dexmedetomidine; mortality; outcomes.

Copyright © 2014 Elsevier Inc. All rights reserved.

Figures

Figure 1

Recruiting of study samples.

Figure 2

Parsimonious multivariable propensity model for dexmedetomidine use. OR, odds ratio; CI, confidence interval; CHF, congestive heart failure; DEX, dexmedetomidine

Figure 3

Effects of dexmedetomidine on postoperative complications and mortality in patients undergoing CABG surgery. Values are numbers (%) for categorical variables and mean± SD for continuous variables. OR, odd ratio; CI, confidence interval; MI, myocardial infarction; RF, renal failure; Post-op, post-operative; ICU, Intensive care unit; LOS, length of stay; DEX, dexmedetomidine.

Figure 4

Survival estimates after CABG surgery between two groups. Survival probability were calculated with the use of Kaplan-Meier methods and compared with the use of a Log-rank test (Log -Rank test, Chi-Square=5.6312, p=0.0176). DEX group, using dexmedetomidine after weaning off bypass; Non-DEX, not using dexmedetomidine after weaning off bypass.

Figure 5

Cox proportional hazard model for 1-year mortality following cardiac surgery. Values are numbers (%) for categorical variables and mean± SD for continuous variables. CI, confidence interval