Dexmedetomidine associated with improved outcomes after cardiac surgery

Patients who receive dexmedetomidine after cardiac surgery may have lower postoperative rates of mortality as well as complications, according to a new study.

Researchers performed a retrospective cohort study at a single medical center to examine whether patients who received dexmedetomidine after coronary artery bypass grafting (CABG) alone or CABG plus valvular or other procedures had better rates of postoperative complications and mortality.

The study's primary outcome measures were mortality and postoperative major adverse cardiocerebral events, including stroke, coma, perioperative myocardial infarction, heart block or cardiac arrest. Secondary outcomes were renal failure, sepsis, delirium, postoperative hours spent on a ventilator, length of hospital stay and 30-day readmission rates. The study results were publishedonline March 19 by Circulation.

Overall, 1,134 patients were included in the study, 568 who received intravenous dexmedetomidine infusion and 566 who did not. Approximately 71% of patients were men, and most (67.6%) were white. Those in the dexmedetomidine group had significantly lower mortality rates in the hospital postsurgery (1.23% vs. 4.59%; adjusted odds ratio, 0.34; P<0.0001), at 30 days (1.76% vs. 5.12%; adjusted odds ratio, 0.39; P<0.0001), and at one year (3.17% vs. 7.95%; adjusted odds ratio, 0.47; P=0.0002). Risk for overall complications (47.18% vs. 54.06%; adjusted odds ratio, 0.80; P=0.0136) and delirium (5.46% vs. 7.42%; adjusted odds ratio, 0.53; P=0.0030) was also lower in the dexmedetomidine group.

The authors noted that their study was limited by its observational cohort design and its use of data from a voluntary database, among other factors. However, they concluded that perioperative use of dexmedetomidine was associated with lower postoperative mortality for up to one year, as well as lower rates of all postoperative complications and delirium in patients undergoing cardiac surgery. They called for additional multicenter randomized trials to confirm their findings.