Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center
Background: Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high d...
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Elsevier
2025-02-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664624003553 |
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| author | Jeng-Wei Chen Hsiu-Wen Liang Bo-Wei Fong Chih-Yang Chan Heng-Wen Chou Nai-Kuan Chou Chih-Hsien Wang Nai-Hsin Chi I-Hui Wu Shu-Chien Huang Hsi-Yu Yu Yih-Sharng Chen Ron-Bin Hsu |
| author_facet | Jeng-Wei Chen Hsiu-Wen Liang Bo-Wei Fong Chih-Yang Chan Heng-Wen Chou Nai-Kuan Chou Chih-Hsien Wang Nai-Hsin Chi I-Hui Wu Shu-Chien Huang Hsi-Yu Yu Yih-Sharng Chen Ron-Bin Hsu |
| author_sort | Jeng-Wei Chen |
| collection | DOAJ |
| description | Background: Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high dose of 1,000 mg of methylprednisolone was used to attenuate the inflammatory response associated with CPB. Our institution aligned with guideline recommendations and gradually reduced methylprednisolone dosages; thus, we reevaluated the impact on postoperative clinical outcomes. Methods: Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups. Results: We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group. Conclusion: The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications. |
| format | Article |
| id | doaj-art-18a419a9ee6e4cb6a68507df7bdb6df7 |
| institution | Kabale University |
| issn | 0929-6646 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj-art-18a419a9ee6e4cb6a68507df7bdb6df72025-02-02T05:26:48ZengElsevierJournal of the Formosan Medical Association0929-66462025-02-011242118125Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical centerJeng-Wei Chen0Hsiu-Wen Liang1Bo-Wei Fong2Chih-Yang Chan3Heng-Wen Chou4Nai-Kuan Chou5Chih-Hsien Wang6Nai-Hsin Chi7I-Hui Wu8Shu-Chien Huang9Hsi-Yu Yu10Yih-Sharng Chen11Ron-Bin Hsu12Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROC; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROC; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROCDepartment of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan ROC; Corresponding author. National Taiwan University Hospital No. 7, Chung-Shan S. Rd., Taipei, Taiwan 100, Taiwan ROC.Background: Current adult cardiac surgery guidelines recommend against the routine use of prophylactic intravenous corticosteroids during cardiopulmonary bypass (CPB) due to concerns about myocardial injury, despite their potential to reduce postoperative atrial fibrillation. Traditionally, a high dose of 1,000 mg of methylprednisolone was used to attenuate the inflammatory response associated with CPB. Our institution aligned with guideline recommendations and gradually reduced methylprednisolone dosages; thus, we reevaluated the impact on postoperative clinical outcomes. Methods: Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups. Results: We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group. Conclusion: The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications.http://www.sciencedirect.com/science/article/pii/S0929664624003553Cardiac surgerySteroidCardiopulmonary bypassOutcome |
| spellingShingle | Jeng-Wei Chen Hsiu-Wen Liang Bo-Wei Fong Chih-Yang Chan Heng-Wen Chou Nai-Kuan Chou Chih-Hsien Wang Nai-Hsin Chi I-Hui Wu Shu-Chien Huang Hsi-Yu Yu Yih-Sharng Chen Ron-Bin Hsu Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center Journal of the Formosan Medical Association Cardiac surgery Steroid Cardiopulmonary bypass Outcome |
| title | Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center |
| title_full | Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center |
| title_fullStr | Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center |
| title_full_unstemmed | Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center |
| title_short | Effects and trend of steroid dosage reduction during cardiac surgery: A three-year retrospective analysis at a tertiary medical center |
| title_sort | effects and trend of steroid dosage reduction during cardiac surgery a three year retrospective analysis at a tertiary medical center |
| topic | Cardiac surgery Steroid Cardiopulmonary bypass Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S0929664624003553 |
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