Intraoperative corticosteroid administration and postoperative pulmonary complications: a secondary analysis of the iPROVE clinical trials.
Andres Zorrilla-Vaca, Daniel A Zapata-Pena, Matthew B Allen et al.
✦ AI-curated · Sources linked
In 30 seconds
This post hoc, weighted secondary analysis of two multicentre randomised clinical trials examined whether intraoperative corticosteroids given at antiemetic doses were associated with postoperative pulmonary complications in adults undergoing major abdominal or thoracic surgery. Among 1963 patients, the adjusted analysis found no significant reduction in pulmonary complications within 30 days (OR 0.86, 95% CI 0.62-1.18, P=0.347). Corticosteroid recipients had a modestly higher PACU arterial oxygen-to-inspired oxygen ratio, but the findings do not establish a reduction in postoperative complications.
Key findings
- Before weighting, severe pulmonary complications occurred in 9.3% [107/1142] of corticosteroid recipients versus 14.0% [113/821] of non-recipients (P=0.002).
- After weighting, corticosteroids were not associated with significantly fewer pulmonary complications (OR 0.86, 95% CI 0.62-1.18, P=0.347).
- PACU oxygenation ratios were modestly higher with corticosteroids (adjusted mean difference 19.9 mm Hg, 95% CI 0.64-39.1, corrected P=0.043).
Why it matters
The unadjusted difference in severe complications did not persist after balancing groups for preoperative confounders, underscoring the importance of adjusted analyses when interpreting treatment associations. The observed PACU oxygenation improvement is a physiological outcome and should be distinguished from evidence of fewer clinically defined pulmonary complications.
What to keep in mind
This was a post hoc analysis, and corticosteroid exposure was not randomly assigned within the analysis; weighting can address measured preoperative confounders but may not eliminate residual confounding.