Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery

Nadia A. Clarizia, Cedric Manlhiot, Steven M. Schwartz, V. Ben Sivarajan, Robert Maratta, Helen M. Holtby, Colleen E. Gruenwald, Christopher A. Caldarone, Glen S. Van Arsdell, Brian W. McCrindle

Research output: Contribution to journalArticle

Abstract

Background Corticosteroids are commonly administered perioperatively in pediatric cardiac surgery to reduce cardiopulmonary bypass induced inflammation. However, their effects on outcomes and potential for adverse events are not well defined. Methods A review was undertaken of cardiac operations between September 2004 and December 2007 carrying a comprehensive Aristotle score 10 or greater. A nonrandomized comparison was undertaken comparing those patients having received intraoperative methylprednisolone at anesthesia induction or in the bypass circuit prime with those who did not. To account for nonrandom assignment of steroid use, a propensity model was created to establish each patient's probability of having received steroids (∼150 variables evaluated, 17 in final model, c-stat 0.94, p < 0.001). Associations between postoperative outcomes and intraoperative steroid use were modeled in multivariable linear regression models adjusted for propensity score and relevant surgical characteristics. Results In 221 identified cases, 134 (61%) patients received intraoperative steroids; of these, 44 (33%) also received preoperative doses. In propensity-adjusted regression models, intraoperative steroid use was associated with lower chest tube volume loss in the first 24 postoperative hours (-5.3 mL/kg, p < 0.001), and shorter durations of stay in intensive care (-2.3 days, p < 0.001) and hospital (-4.1 days, p < 0.001). Use of an additional preoperative dose resulted in further improvements, especially a reduction in duration of mechanical ventilation (-1.7 days versus no steroids, -1.2 days versus intraoperative steroids only, p = 0.002). Steroids were not associated with increased postoperative lactate, creatinine, or glucose levels, or odds of infection. Conclusions Intraoperative steroid use is associated with improved postoperative outcomes for children undergoing high-risk cardiac surgery, with further benefits associated with a preoperative dose.

Original languageEnglish (US)
Pages (from-to)1222-1227
Number of pages6
JournalAnnals of Thoracic Surgery
Volume91
Issue number4
DOIs
StatePublished - Apr 1 2011
Externally publishedYes

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Thoracic Surgery
Steroids
Pediatrics
Linear Models
Chest Tubes
Propensity Score
Methylprednisolone
Critical Care
Cardiopulmonary Bypass
Artificial Respiration
Lactic Acid
Creatinine
Adrenal Cortex Hormones
Anesthesia
Inflammation
Glucose
Infection

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Clarizia, N. A., Manlhiot, C., Schwartz, S. M., Sivarajan, V. B., Maratta, R., Holtby, H. M., ... McCrindle, B. W. (2011). Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery. Annals of Thoracic Surgery, 91(4), 1222-1227. https://doi.org/10.1016/j.athoracsur.2010.11.005

Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery. / Clarizia, Nadia A.; Manlhiot, Cedric; Schwartz, Steven M.; Sivarajan, V. Ben; Maratta, Robert; Holtby, Helen M.; Gruenwald, Colleen E.; Caldarone, Christopher A.; Van Arsdell, Glen S.; McCrindle, Brian W.

In: Annals of Thoracic Surgery, Vol. 91, No. 4, 01.04.2011, p. 1222-1227.

Research output: Contribution to journalArticle

Clarizia, NA, Manlhiot, C, Schwartz, SM, Sivarajan, VB, Maratta, R, Holtby, HM, Gruenwald, CE, Caldarone, CA, Van Arsdell, GS & McCrindle, BW 2011, 'Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery', Annals of Thoracic Surgery, vol. 91, no. 4, pp. 1222-1227. https://doi.org/10.1016/j.athoracsur.2010.11.005
Clarizia, Nadia A. ; Manlhiot, Cedric ; Schwartz, Steven M. ; Sivarajan, V. Ben ; Maratta, Robert ; Holtby, Helen M. ; Gruenwald, Colleen E. ; Caldarone, Christopher A. ; Van Arsdell, Glen S. ; McCrindle, Brian W. / Improved outcomes associated with intraoperative steroid use in high-risk pediatric cardiac surgery. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 4. pp. 1222-1227.
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abstract = "Background Corticosteroids are commonly administered perioperatively in pediatric cardiac surgery to reduce cardiopulmonary bypass induced inflammation. However, their effects on outcomes and potential for adverse events are not well defined. Methods A review was undertaken of cardiac operations between September 2004 and December 2007 carrying a comprehensive Aristotle score 10 or greater. A nonrandomized comparison was undertaken comparing those patients having received intraoperative methylprednisolone at anesthesia induction or in the bypass circuit prime with those who did not. To account for nonrandom assignment of steroid use, a propensity model was created to establish each patient's probability of having received steroids (∼150 variables evaluated, 17 in final model, c-stat 0.94, p < 0.001). Associations between postoperative outcomes and intraoperative steroid use were modeled in multivariable linear regression models adjusted for propensity score and relevant surgical characteristics. Results In 221 identified cases, 134 (61{\%}) patients received intraoperative steroids; of these, 44 (33{\%}) also received preoperative doses. In propensity-adjusted regression models, intraoperative steroid use was associated with lower chest tube volume loss in the first 24 postoperative hours (-5.3 mL/kg, p < 0.001), and shorter durations of stay in intensive care (-2.3 days, p < 0.001) and hospital (-4.1 days, p < 0.001). Use of an additional preoperative dose resulted in further improvements, especially a reduction in duration of mechanical ventilation (-1.7 days versus no steroids, -1.2 days versus intraoperative steroids only, p = 0.002). Steroids were not associated with increased postoperative lactate, creatinine, or glucose levels, or odds of infection. Conclusions Intraoperative steroid use is associated with improved postoperative outcomes for children undergoing high-risk cardiac surgery, with further benefits associated with a preoperative dose.",
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AU - Clarizia, Nadia A.

AU - Manlhiot, Cedric

AU - Schwartz, Steven M.

AU - Sivarajan, V. Ben

AU - Maratta, Robert

AU - Holtby, Helen M.

AU - Gruenwald, Colleen E.

AU - Caldarone, Christopher A.

AU - Van Arsdell, Glen S.

AU - McCrindle, Brian W.

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N2 - Background Corticosteroids are commonly administered perioperatively in pediatric cardiac surgery to reduce cardiopulmonary bypass induced inflammation. However, their effects on outcomes and potential for adverse events are not well defined. Methods A review was undertaken of cardiac operations between September 2004 and December 2007 carrying a comprehensive Aristotle score 10 or greater. A nonrandomized comparison was undertaken comparing those patients having received intraoperative methylprednisolone at anesthesia induction or in the bypass circuit prime with those who did not. To account for nonrandom assignment of steroid use, a propensity model was created to establish each patient's probability of having received steroids (∼150 variables evaluated, 17 in final model, c-stat 0.94, p < 0.001). Associations between postoperative outcomes and intraoperative steroid use were modeled in multivariable linear regression models adjusted for propensity score and relevant surgical characteristics. Results In 221 identified cases, 134 (61%) patients received intraoperative steroids; of these, 44 (33%) also received preoperative doses. In propensity-adjusted regression models, intraoperative steroid use was associated with lower chest tube volume loss in the first 24 postoperative hours (-5.3 mL/kg, p < 0.001), and shorter durations of stay in intensive care (-2.3 days, p < 0.001) and hospital (-4.1 days, p < 0.001). Use of an additional preoperative dose resulted in further improvements, especially a reduction in duration of mechanical ventilation (-1.7 days versus no steroids, -1.2 days versus intraoperative steroids only, p = 0.002). Steroids were not associated with increased postoperative lactate, creatinine, or glucose levels, or odds of infection. Conclusions Intraoperative steroid use is associated with improved postoperative outcomes for children undergoing high-risk cardiac surgery, with further benefits associated with a preoperative dose.

AB - Background Corticosteroids are commonly administered perioperatively in pediatric cardiac surgery to reduce cardiopulmonary bypass induced inflammation. However, their effects on outcomes and potential for adverse events are not well defined. Methods A review was undertaken of cardiac operations between September 2004 and December 2007 carrying a comprehensive Aristotle score 10 or greater. A nonrandomized comparison was undertaken comparing those patients having received intraoperative methylprednisolone at anesthesia induction or in the bypass circuit prime with those who did not. To account for nonrandom assignment of steroid use, a propensity model was created to establish each patient's probability of having received steroids (∼150 variables evaluated, 17 in final model, c-stat 0.94, p < 0.001). Associations between postoperative outcomes and intraoperative steroid use were modeled in multivariable linear regression models adjusted for propensity score and relevant surgical characteristics. Results In 221 identified cases, 134 (61%) patients received intraoperative steroids; of these, 44 (33%) also received preoperative doses. In propensity-adjusted regression models, intraoperative steroid use was associated with lower chest tube volume loss in the first 24 postoperative hours (-5.3 mL/kg, p < 0.001), and shorter durations of stay in intensive care (-2.3 days, p < 0.001) and hospital (-4.1 days, p < 0.001). Use of an additional preoperative dose resulted in further improvements, especially a reduction in duration of mechanical ventilation (-1.7 days versus no steroids, -1.2 days versus intraoperative steroids only, p = 0.002). Steroids were not associated with increased postoperative lactate, creatinine, or glucose levels, or odds of infection. Conclusions Intraoperative steroid use is associated with improved postoperative outcomes for children undergoing high-risk cardiac surgery, with further benefits associated with a preoperative dose.

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