title: Intraoperative High-Dose Dexamethasone in Cardiac Surgery and the Risk of Rethoracotomy.
abstract: BACKGROUND
  Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficial effect of dexamethasone on major adverse events in cardiac surgical patients. Previous studies suggest that corticosteroids may affect postoperative coagulation and blood loss, and therefore could influence the risk of surgical reinterventions. We investigated the effects of prophylactic intraoperative dexamethasone treatment on the rate of rethoracotomy after cardiac surgery.
  
  
  METHODS
  We performed a post-hoc additional data collection and analysis in the DECS trial. A total of 4,494 adult patients undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to intravenous dexamethasone (1.0 mg/kg) or placebo. The primary endpoint for the present study was the incidence of any rethoracotomy within the first 30 postoperative days. Secondary endpoints included the reason for rethoracotomy and the incidence of perioperative transfusion of blood products.
  
  
  RESULTS
  In the dexamethasone group, 217 patients (9.7%) underwent a rethoracotomy, and in the placebo group, 165 patients did (7.3%; relative risk 1.32, 95% confidence interval: 1.09 to 1.61, p = 0.005). The most common reason for rethoracotomy was tamponade in both groups: 3.9% versus 2.1%, respectively (relative risk 1.84, 95% confidence interval: 1.30 to 2.61, p < 0.001).
  
  
  CONCLUSIONS
  Intraoperative high-dose dexamethasone administration in cardiac surgery was associated with an increased rethoracotomy risk.
authors: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: d.vanosch@umcutrecht.nl.
authors: Dirk
authors: D
authors: van Osch
authors: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Jan M
authors: JM
authors: Dieleman
authors: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Hendrik M
authors: HM
authors: Nathoe
authors: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Marc P
authors: MP
authors: Boasson
authors: Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Jolanda
authors: J
authors: Kluin
authors: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Jeroen J H
authors: JJ
authors: Bunge
authors: Department of Anesthesiology and Intensive Care, Isala Klinieken, Zwolle, Netherlands.
authors: Arno P
authors: AP
authors: Nierich
authors: Department of Anesthesiology and Intensive Care, Amphia Ziekenhuis, Breda, Netherlands.
authors: Peter M
authors: PM
authors: Rosseel
authors: Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands.
authors: Joost M
authors: JM
authors: van der Maaten
authors: Department of Anesthesiology and Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands.
authors: Jan
authors: J
authors: Hofland
authors: Department of Anesthesiology and Intensive Care, Medisch Spectrum Twente, Enschede, Netherlands.
authors: Jan C
authors: JC
authors: Diephuis
authors: Department of Anesthesiology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
authors: Fellery
authors: F
authors: de Lange
authors: Department of Anesthesiology, Vrije Universiteit Medisch Centrum, Amsterdam, Netherlands.
authors: Christa
authors: C
authors: Boer
authors: Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors: Diederik
authors: D
authors: van Dijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology / Q000517:prevention & control*; D007275:Injections, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone