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A4224
October 09, 2021
10/9/2021 7:45:00 AM - 10/12/2021 3:00:00 PM
Room Virtual
Effects Of Intraoperative Dexamethasone On Mortality In Patients Undergoing Cancer Surgery
Michael Blank, Student, Luca J. Wachtendorf, Student, Omid Azimaraghi, M.D., Peter Santer, M.D., Maximilian S. Schaefer, M.D., Matthias Eikermann, M.D., Anastasia Katsiampoura, M.D.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
Disclosures:  M. Blank: None. L. Wachtendorf: None. O. Azimaraghi: None. P. Santer: None. M.S. Schaefer: None. M. Eikermann: Funded Research; Self; funding for investigator-initiated trials not relate
Background: Dexamethasone is an antiemetic drug used for the prevention of nausea and vomiting after surgery (PONV) and during emetogenic chemotherapies [1,2]. In acute myeloid leukemia, dexamethasone demonstrated antileukemic activity due to a potential modulation of inflammatory chemoresistance pathways [3]. In vitro dexamethasone expresses effects resulting in decreased tumor growth in pancreatic, breast and lung cancer cells [4-6]. Recent data suggest that dexamethasone administration during surgery can decrease mortality in patients undergoing cancer surgery [7]. In this study, we hypothesized that intraoperative administration of dexamethasone decreases mortality in patients undergoing cancer surgery.

Methods: 74,058 adult patients undergoing surgery to remove solid malignancies between 2005 and 2020 at Beth Israel Deaconess Medical Center (Boston, MA, USA) and between 2007 and 2015 at Massachusetts General Hospital (Boston, MA, USA) were included in this study. The primary exposure was intraoperative administration of dexamethasone and the primary outcome was mortality within 90 days after surgery. Multivariable logistic regression adjusted for a priori defined covariates, including patient demographics, comorbidities, and markers of procedural severity as well as preoperative administered steroids and chemotherapies was applied.

Results: 34.0% (25,178/74,058) of patients undergoing cancer surgery received intraoperative dexamethasone (mean dose [SD]: 7.0 [±2.4] mg). 0.83% (209/25,178) of patients who received dexamethasone died within 90 days after surgery compared to 3.2% (1,543/48,880) of the patients who did not receive dexamethasone. After adjusting for a priori defined covariates, including patient demographics, comorbidities, intraoperative factors as well as preoperative steroid administrations and chemotherapies, intraoperative administration of dexamethasone was associated with a decreased risk of 90-day mortality (adjusted odds ratio [aOR] 0.68; 95% confidence interval [CI]: 0.57-0.81; p<0.001). Subgroup analyses demonstrated robust effects in patients undergoing surgery for treatment of breast cancer (aOR: 0.22; 95% CI: 0.11-0.45; p<0.001), and gynecological malignancies of the reproductive organs (Ovary, Uterus, Cervix) (aOR: 0.33; 95% CI: 0.16-0.66; p=0.002).

Conclusion: Administration of dexamethasone during surgery used for prophylaxis of PONV is associated with lower 90 day mortality in patients undergoing cancer surgery. These data support the use of dexamethasone for antiemetic prophylaxis of patients undergoing cancer surgery.

Figure 1

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