Authors: van Steenbergen GJ et al.
Anesthesia & Analgesia 141(6):1216–1225, December 2025.
Summary
This retrospective, population-level analysis used data from the Netherlands Heart Registration to evaluate whether prophylactic dexamethasone affects postoperative outcomes in adult cardiac surgery. The study included 54,694 elective and urgent on-pump cardiac surgery patients from 2013 to 2021; 74.8% received perioperative dexamethasone.
Using propensity score matching to control for confounders, dexamethasone use was associated with a significantly lower risk of the composite clinical outcome (30-day mortality, in-hospital stroke, renal failure, or respiratory failure) with an odds ratio of 0.82 (95% CI 0.72–0.92). This improvement was largely driven by a marked reduction in renal failure (OR 0.57; 95% CI 0.47–0.70). Patients receiving dexamethasone also had a modest but significant reduction in length of stay.
Other components of the composite outcome—including stroke, respiratory failure, and 30-day mortality—did not show significant overall improvement. Notably, in patients older than 80 years, dexamethasone use was associated with increased 30-day mortality (OR 1.52; 95% CI 1.01–2.28). These age-specific findings suggest heterogeneity of effect and raise the hypothesis that elderly patients may respond differently to perioperative steroids.
A national survey of Dutch cardiac anesthesiologists revealed substantial variability in steroid practice patterns, underscoring the lack of consensus despite widespread use.
Key Points
• Among nearly 55,000 cardiac surgery patients, dexamethasone use was associated with fewer major complications.
• Renal failure was significantly reduced after steroid administration.
• Hospital length of stay was modestly but significantly shorter.
• No overall mortality benefit was observed; in patients over 80, dexamethasone was associated with higher 30-day mortality.
• Significant practice variation exists, emphasizing the need for clearer guidance and further targeted research.
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