Abstract：
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：由于担心心肌损伤，目前的成人心脏手术指南建议不要在体外循环（CPB）期间常规使用预防性静脉注射皮质类固醇，尽管它们有可能减少术后心房颤动。传统上,1,000mg甲基强的松龙的高剂量用于减轻与CPB相关的炎症反应.我们的机构与指南建议保持一致，并逐渐减少甲基强的松龙的剂量；因此，我们重新评估了对术后临床结局的影响.
方法：我们的研究回顾了在2019年6月至2022年5月期间进行的1680例成人心脏手术中的1341例病例，这些病例排除了非体外循环手术的病例。心室辅助装置植入,心脏移植,需要全身循环停止的主动脉手术。该研究及时排序，包括2018年的基线数据，以及2019年以来的其他三个时期，以分析三种不同剂量的甲基强的松龙的影响：0mg，500毫克，和1000毫克。我们评估了甲基强的松龙给药的年度趋势，并比较了各组的发病率和死亡率。
结果：我们观察到类固醇使用显着下降，到第3期，无类固醇手术从23%增加到66.5%。尽管减少了类固醇的使用，我们的研究显示死亡率没有增加，新发心房颤动,急性肾损伤，与基线数据相比，脑血管事件和通气时间延长。值得注意的是,无类固醇组手术部位感染率较低.
结论：数据表明，在CPB期间减少或停用类固醇可以在不影响患者预后的情况下进行。这可以支持在成人心脏手术中更保守地使用类固醇的过渡，符合当前的指导方针，并有可能减少某些术后并发症。
方法：我们的研究回顾了在2019年6月至2022年5月期间进行的1680例成人心脏手术中的1341例病例，这些病例排除了非体外循环手术的病例。心室辅助装置植入,心脏移植,需要全身循环停止的主动脉手术。该研究及时排序，包括2018年的基线数据，以及2019年以来的其他三个时期，以分析三种不同剂量的甲基强的松龙的影响：0mg，500毫克，和1000毫克。我们评估了甲基强的松龙给药的年度趋势，并比较了各组的发病率和死亡率。
结果：我们观察到类固醇使用显着下降，到第3期，无类固醇手术从23%增加到66.5%。尽管减少了类固醇的使用，我们的研究显示死亡率没有增加，新发心房颤动,急性肾损伤，与基线数据相比，脑血管事件和通气时间延长。值得注意的是,无类固醇组手术部位感染率较低.
结论：数据表明，在CPB期间减少或停用类固醇可以在不影响患者预后的情况下进行。这可以支持在成人心脏手术中更保守地使用类固醇的过渡，符合当前的指导方针，并有可能减少某些术后并发症。
