Dexmedetomidine, Delirium, and Adverse Outcomes: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
Analgesics, Non-Narcotic
/ adverse effects
Cardiac Surgical Procedures
/ adverse effects
Delirium
/ epidemiology
Dexmedetomidine
/ adverse effects
Humans
Incidence
Pain, Postoperative
/ prevention & control
Postoperative Complications
/ epidemiology
Propensity Score
Retrospective Studies
Societies, Medical
/ statistics & numerical data
Thoracic Surgery
/ statistics & numerical data
United States
/ epidemiology
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
19
08
2020
revised:
24
02
2021
accepted:
01
03
2021
pubmed:
27
4
2021
medline:
1
12
2021
entrez:
26
4
2021
Statut:
ppublish
Résumé
We tested the hypothesis that dexmedetomidine was associated with a reduced incidence of postoperative delirium (POD) and adverse outcomes in cardiac surgery patients from The Society of Thoracic Surgeons Adult Cardiac Surgery Database including the Adult Cardiac Anesthesiology subsection. We identified 55,905 patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent cardiac surgery between July 2014 and December 2018. Using propensity score-weighted regression analysis, we analyzed the effect of intraoperative dexmedetomidine on the primary (POD) and secondary outcomes (highest pain score on day 3 and at discharge, stroke, prolonged ventilation, postoperative intubation/reintubation, additional postoperative hours ventilated, renal failure, atrial fibrillation, and 30-day mortality). In separate propensity score-weighted analyses, we examined the effect of postoperative dexmedetomidine on the highest postoperative pain score at discharge and 30-day mortality. The rate of intraoperative dexmedetomidine use was 25.5% (n = 13,963), and its administration was associated with increased odds for POD (odds ratio, 1.85; 95% confidence interval [CI], 1.60-2.13), a small higher average pain score on day 3 (mean difference, 0.08; 95% CI, 0.02-0.14), increased odds for postoperative intubation/reintubation (odds ratio, 1.29; 95% CI, 1.12-1.48), and a small lower average pain score at discharge (mean difference, -0.31; 95% CI, -0.21 to-0.41). Postoperative dexmedetomidine was associated with a small higher average pain score at discharge (mean difference, 0.27; 95% CI, 0.21-0.34) and higher odds for 30-day mortality (odds ratio, 1.25, 95% CI, 1.07-1.46). In this registry of cardiac surgical patients dexmedetomidine administration was associated with POD and adverse outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
We tested the hypothesis that dexmedetomidine was associated with a reduced incidence of postoperative delirium (POD) and adverse outcomes in cardiac surgery patients from The Society of Thoracic Surgeons Adult Cardiac Surgery Database including the Adult Cardiac Anesthesiology subsection.
METHODS
METHODS
We identified 55,905 patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent cardiac surgery between July 2014 and December 2018. Using propensity score-weighted regression analysis, we analyzed the effect of intraoperative dexmedetomidine on the primary (POD) and secondary outcomes (highest pain score on day 3 and at discharge, stroke, prolonged ventilation, postoperative intubation/reintubation, additional postoperative hours ventilated, renal failure, atrial fibrillation, and 30-day mortality). In separate propensity score-weighted analyses, we examined the effect of postoperative dexmedetomidine on the highest postoperative pain score at discharge and 30-day mortality.
RESULTS
RESULTS
The rate of intraoperative dexmedetomidine use was 25.5% (n = 13,963), and its administration was associated with increased odds for POD (odds ratio, 1.85; 95% confidence interval [CI], 1.60-2.13), a small higher average pain score on day 3 (mean difference, 0.08; 95% CI, 0.02-0.14), increased odds for postoperative intubation/reintubation (odds ratio, 1.29; 95% CI, 1.12-1.48), and a small lower average pain score at discharge (mean difference, -0.31; 95% CI, -0.21 to-0.41). Postoperative dexmedetomidine was associated with a small higher average pain score at discharge (mean difference, 0.27; 95% CI, 0.21-0.34) and higher odds for 30-day mortality (odds ratio, 1.25, 95% CI, 1.07-1.46).
CONCLUSIONS
CONCLUSIONS
In this registry of cardiac surgical patients dexmedetomidine administration was associated with POD and adverse outcomes.
Identifiants
pubmed: 33901455
pii: S0003-4975(21)00725-6
doi: 10.1016/j.athoracsur.2021.03.098
pii:
doi:
Substances chimiques
Analgesics, Non-Narcotic
0
Dexmedetomidine
67VB76HONO
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1886-1892Informations de copyright
Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.