Perioperative dexmedetomidine improves outcomes of cardiac surgery

Fuhai Ji, Zhongmin Li, Hung Nguyen, J Nilas Young, Pengcai Shi, Neal Fleming, Hong Liu

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Background-Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality after cardiac surgery. Methods and Results-A total of 1134 patients who underwent coronary artery bypass surgery and coronary artery bypass surgery plus valvular or other procedures were included. Of them, 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores, and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (stroke, coma, perioperative myocardial infarction, heart block, or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay, and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital (1.23% versus 4.59%; adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614; P>0.0001), 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95% confidence interval, 0.226-0.655; P>0.0001), and 1-year (3.17% versus 7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701; P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18% versus 54.06%; adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and delirium (5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75; P=0.0030). Conclusion-Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.

Original languageEnglish (US)
Pages (from-to)1576-1584
Number of pages9
JournalCirculation
Volume127
Issue number15
DOIs
StatePublished - Apr 16 2013

Fingerprint

Dexmedetomidine
Thoracic Surgery
Odds Ratio
Confidence Intervals
Delirium
Mortality
Heart Arrest
Coronary Artery Bypass
Length of Stay
Propensity Score
Heart Block
Incidence
Coma
Intravenous Infusions
Health Care Costs
Renal Insufficiency
Ventilation
Sepsis
Retrospective Studies
Logistic Models

Keywords

  • Cardiovascular surgical procedures
  • Complications
  • Dexmedetomidine
  • Mortality

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Perioperative dexmedetomidine improves outcomes of cardiac surgery. / Ji, Fuhai; Li, Zhongmin; Nguyen, Hung; Young, J Nilas; Shi, Pengcai; Fleming, Neal; Liu, Hong.

In: Circulation, Vol. 127, No. 15, 16.04.2013, p. 1576-1584.

Research output: Contribution to journalArticle

Ji, Fuhai ; Li, Zhongmin ; Nguyen, Hung ; Young, J Nilas ; Shi, Pengcai ; Fleming, Neal ; Liu, Hong. / Perioperative dexmedetomidine improves outcomes of cardiac surgery. In: Circulation. 2013 ; Vol. 127, No. 15. pp. 1576-1584.
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abstract = "Background-Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality after cardiac surgery. Methods and Results-A total of 1134 patients who underwent coronary artery bypass surgery and coronary artery bypass surgery plus valvular or other procedures were included. Of them, 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores, and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (stroke, coma, perioperative myocardial infarction, heart block, or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay, and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital (1.23{\%} versus 4.59{\%}; adjusted odds ratio, 0.34; 95{\%} confidence interval, 0.192-0.614; P>0.0001), 30-day (1.76{\%} versus 5.12{\%}; adjusted odds ratio, 0.39; 95{\%} confidence interval, 0.226-0.655; P>0.0001), and 1-year (3.17{\%} versus 7.95{\%}; adjusted odds ratio, 0.47; 95{\%} confidence interval, 0.312-0.701; P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18{\%} versus 54.06{\%}; adjusted odds ratio, 0.80; 95{\%} confidence interval, 0.68-0.96; P=0.0136) and delirium (5.46{\%} versus 7.42{\%}; adjusted odds ratio, 0.53; 95{\%} confidence interval, 0.37-0.75; P=0.0030). Conclusion-Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.",
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AU - Ji, Fuhai

AU - Li, Zhongmin

AU - Nguyen, Hung

AU - Young, J Nilas

AU - Shi, Pengcai

AU - Fleming, Neal

AU - Liu, Hong

PY - 2013/4/16

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N2 - Background-Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality after cardiac surgery. Methods and Results-A total of 1134 patients who underwent coronary artery bypass surgery and coronary artery bypass surgery plus valvular or other procedures were included. Of them, 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores, and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (stroke, coma, perioperative myocardial infarction, heart block, or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay, and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital (1.23% versus 4.59%; adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614; P>0.0001), 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95% confidence interval, 0.226-0.655; P>0.0001), and 1-year (3.17% versus 7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701; P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18% versus 54.06%; adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and delirium (5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75; P=0.0030). Conclusion-Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.

AB - Background-Cardiac surgery is associated with a high risk of cardiovascular and other complications that translate into increased mortality and healthcare costs. This retrospective study was designed to determine whether the perioperative use of dexmedetomidine could reduce the incidence of complications and mortality after cardiac surgery. Methods and Results-A total of 1134 patients who underwent coronary artery bypass surgery and coronary artery bypass surgery plus valvular or other procedures were included. Of them, 568 received intravenous dexmedetomidine infusion and 566 did not. Data were adjusted with propensity scores, and multivariate logistic regression was used. The primary outcomes measured included mortality and postoperative major adverse cardiocerebral events (stroke, coma, perioperative myocardial infarction, heart block, or cardiac arrest). Secondary outcomes included renal failure, sepsis, delirium, postoperative ventilation hours, length of hospital stay, and 30-day readmission. Dexmedetomidine use significantly reduced postoperative in-hospital (1.23% versus 4.59%; adjusted odds ratio, 0.34; 95% confidence interval, 0.192-0.614; P>0.0001), 30-day (1.76% versus 5.12%; adjusted odds ratio, 0.39; 95% confidence interval, 0.226-0.655; P>0.0001), and 1-year (3.17% versus 7.95%; adjusted odds ratio, 0.47; 95% confidence interval, 0.312-0.701; P=0.0002) mortality. Perioperative dexmedetomidine therapy also reduced the risk of overall complications (47.18% versus 54.06%; adjusted odds ratio, 0.80; 95% confidence interval, 0.68-0.96; P=0.0136) and delirium (5.46% versus 7.42%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37-0.75; P=0.0030). Conclusion-Perioperative dexmedetomidine use was associated with a decrease in postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery.

KW - Cardiovascular surgical procedures

KW - Complications

KW - Dexmedetomidine

KW - Mortality

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