Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX)

被引:24
作者
Corcoran, T. [1 ,2 ,3 ,4 ]
Kasza, J. [4 ]
Short, T. G. [5 ]
O'Loughlin, E. [2 ,6 ]
Chan, M. T. V. [7 ]
Leslie, K. [4 ,8 ,9 ,10 ]
Forbes, A. [4 ]
Paech, M. [2 ]
Myles, P. [4 ,11 ]
机构
[1] Royal Perth Hosp, Dept Anaesthesia & Pain Med, Perth, WA, Australia
[2] Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia
[3] Western Australia Hlth Dept, Perth, WA, Australia
[4] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia
[5] Auckland City Hosp, Dept Anaesthesia, Pk Rd, Auckland, New Zealand
[6] Fiona Stanley Hosp, Dept Anaesthesia & Pain Med, Perth, WA, Australia
[7] Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R China
[8] Royal Melbourne Hosp, Dept Anaesthesia & Pain Management, Melbourne, Vic, Australia
[9] Univ Melbourne, Anaesthesia Perioperat & Pain Med Unit, Melbourne, Vic, Australia
[10] Univ Melbourne, Dept Pharmacol & Therapeut, Melbourne, Vic, Australia
[11] Alfred Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic, Australia
基金
澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;
关键词
dexamethasone; nitrous oxide; postoperative nausea and vomiting; surgical wound infection; SURGICAL SITE INFECTION; PERIOPERATIVE DEXAMETHASONE; ANTIEMETIC DEXAMETHASONE; DOSE DEXAMETHASONE; NITROUS-OXIDE; SURGERY; NAUSEA; GLUCOCORTICOIDS; MECHANISMS; ANESTHESIA;
D O I
10.1093/bja/aew446
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. Methods. Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89-1.34; P = 0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity scoreadjusted RR 1.06; 95% CI 0.86-1.30; P = 0.59], quality of recovery score [ median 14, interquartile range (IQR) 12-15, vs median 14, IQR 12-16, P = 0.10), length of stay in the postanaesthesia care unit [ propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P = 0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1-3 [ 182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74; P<0.001] and shorter lengths of stay in hospital [ propensity score-adjusted median ( IQR) 5.0 ( 2.9, 8.2) vs 5.3 ( 3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes. Conclusion. Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. Clinical trial registration. NCT00430989.
引用
收藏
页码:190 / 199
页数:10
相关论文
共 43 条
[1]   Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial [J].
Abdelmalak, B. B. ;
Bonilla, A. ;
Mascha, E. J. ;
Maheshwari, A. ;
Tang, W. H. Wilson ;
You, J. ;
Ramachandran, M. ;
Kirkova, Y. ;
Clair, D. ;
Walsh, R. M. ;
Kurz, A. ;
Sessler, D. I. .
BRITISH JOURNAL OF ANAESTHESIA, 2013, 111 (02) :209-221
[2]   A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study [J].
Austin, Peter C. ;
Grootendorst, Paul ;
Anderson, Geoffrey M. .
STATISTICS IN MEDICINE, 2007, 26 (04) :734-753
[3]  
Bagchi Dipanjan, 2012, J Anaesthesiol Clin Pharmacol, V28, P477, DOI 10.4103/0970-9185.101920
[4]   MULTIPLE MECHANISMS MEDIATE ANTIPYRETIC ACTION OF GLUCOCORTICOIDS [J].
COELHO, MM ;
LUHESHI, G ;
HOPKINS, SJ ;
PELA, IR ;
ROTHWELL, NJ .
AMERICAN JOURNAL OF PHYSIOLOGY-REGULATORY INTEGRATIVE AND COMPARATIVE PHYSIOLOGY, 1995, 269 (03) :R527-R535
[5]   A survey of antiemetic dexamethasone administration-frequency of use and perceptions of benefits and risks [J].
Corcoran, T. B. ;
Edwards, T. .
ANAESTHESIA AND INTENSIVE CARE, 2015, 43 (02) :167-174
[6]   Anti-emetic dexamethasone and postoperative infection risk: a retrospective cohort study [J].
Corcoran, T. B. ;
Truyens, E. B. ;
Ng, A. ;
Moseley, N. ;
Doyle, A. R. ;
Margetts, L. .
ANAESTHESIA AND INTENSIVE CARE, 2010, 38 (04) :654-660
[7]   SURGICAL WOUND-INFECTION RATES BY WOUND CLASS, OPERATIVE PROCEDURE, AND PATIENT RISK INDEX [J].
CULVER, DH ;
HORAN, TC ;
GAYNES, RP ;
MARTONE, WJ ;
JARVIS, WR ;
EMORI, TG ;
BANERJEE, SN ;
EDWARDS, JR ;
TOLSON, JS ;
HENDERSON, TS ;
HUGHES, JM .
AMERICAN JOURNAL OF MEDICINE, 1991, 91 :S152-S157
[8]   The association of perioperative dexamethasone, smoking and alcohol abuse with wound complications after laparotomy [J].
Dahl, Rikke M. ;
Wetterslev, Jorn ;
Jorgensen, Lars N. ;
Rasmussen, Lars S. ;
Moller, Ann M. ;
Meyhoff, Christian S. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2014, 58 (03) :352-361
[9]   Corticosteroid Administration in Oral and Orthognathic Surgery: A Systematic Review of the Literature and Meta-Analysis [J].
Dan, Anne E. B. ;
Thygesen, Torben H. ;
Pinholt, Else M. .
JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, 2010, 68 (09) :2207-2220
[10]   Perineural Dexamethasone to Improve Postoperative Analgesia with Peripheral Nerve Blocks: A Meta-Analysis of Randomized Controlled Trials [J].
De Oliveira, Gildasio S., Jr. ;
Alves, Lucas J. Castro ;
Nader, Autoun ;
Kendall, Mark C. ;
Rahangdale, Rohit ;
McCarthy, Robert J. .
PAIN RESEARCH AND TREATMENT, 2014, 2014