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Intraoperative dexamethasone is associated with a lower risk of respiratory failure in thoracic surgery: Observational cohort study (SURTHODEX) - 05/07/24

Doi : 10.1016/j.accpm.2024.101386 
Rayan Braik a, , Yohan Germain b, Thomas Flet c, Anis Chaba d, Piere-Grégoire Guinot e, Leo Garreau f, Stephane Bar c, Momar Diouf c, Osama Abou-Arab c, Yazine Mahjoub c, Pascal Berna g, Hervé Dupont c
a Sorbonne University, GRC 29, AP-HP, DMU DREAM and Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France 
b Poly clinique Saint Côme, Service d’anesthésie-réanimation, Compiègne, France 
c Centre hospitalier universitaire d’Amiens, Département d’anesthésie-réanimation, Amiens, France 
d Department of Intensive Care, Austin Hospital, Melbourne, Australia 
e Centre hospitalier universitaire de Dijon, Département d’anesthésie-réanimation, Dijon, France 
f Centre hospitalier universitaire de Bordeaux, Département d’anesthésie-réanimation, Bordeaux, France 
g Clinique Victor Pauchet, Service de chirurgie thoracique, Amiens France 

Corresponding author.

Abstract

Background

Postoperative complications, particularly respiratory complications, are of significant clinical concern in patients undergoing elective thoracic surgery. Dexamethasone (DXM), commonly administered to prevent postoperative nausea and vomiting (PONV), has potential anti-inflammatory effects that might be beneficial in reducing these complications. We aimed to investigate whether intraoperative DXM administration could mitigate the occurrence of respiratory complications following elective thoracic surgery.

Methods

We conducted a single-center observational study, including patients who underwent elective thoracic surgery from 2012 to 2020. The primary outcome was the onset of acute respiratory failure within 7 days post-surgery. Secondary outcomes encompassed other postoperative complications, duration of hospital stay, and mortality within 30 days post-surgery. An overlap propensity score analysis was employed to estimate the treatment effect.

Results

We included 1,247 adult patients, 897 who received dexamethasone (DXM) and 350 who served as controls. Intraoperative dexamethasone administration was associated with a significant reduction in respiratory complications with an adjusted relative risk (RR) of 0.65 (95% CI: 0.43−0.97). There was also a significant decline in composite infectious criteria with an adjusted RR of 0.76 (95% CI: 0.63−0.93). Cardiac complications were also assessed as a composite criterion, and a significant reduction was observed (adjusted RR, 0.68; 95% CI, 0.51−0.9). However, there were no association with mechanical complications, mortality within 30 days (adjusted RR of 0.43, 95% CI: 0.17–1.09) or in the length of hospital stay (adjusted RR of 0.85, 95% CI: 0.71–1.02).

Conclusions

Dexamethasone administration was associated with a reduction in postoperative respiratory complications. Further prospective studies are needed to confirm these findings.

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Abbreviations : ARDS, COPD, RR, DXM, PONV, POW, SMD

Keywords : Anesthesiology, Respiratory complications, Corticosteroids, Thoracic surgery, Single lung ventilation


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© 2024  Société française d'anesthésie et de réanimation (Sfar). Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 43 - N° 4

Articolo 101386- Agosto 2024 Ritorno al numero
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