Dexmedetomidine, Delirium, and Adverse Outcomes: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database

Background: We tested the hypothesis that dexmedetomidine was associated with a reduced incidence of postoperative delirium (POD) and adverse outcomes in cardiac surgery patients from The Society of Thoracic Surgeons Adult Cardiac Surgery Database including the Adult Cardiac Anesthesiology subsection. Methods: We identified 55,905 patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent cardiac surgery between July 2014 and December 2018. Using propensity score–weighted regression analysis, we analyzed the effect of intraoperative dexmedetomidine on the primary (POD) and secondary outcomes (highest pain score on day 3 and at discharge, stroke, prolonged ventilation, postoperative intubation/reintubation, additional postoperative hours ventilated, renal failure, atrial fibrillation, and 30-day mortality). In separate propensity score–weighted analyses, we examined the effect of postoperative dexmedetomidine on the highest postoperative pain score at discharge and 30-day mortality. Results: The rate of intraoperative dexmedetomidine use was 25.5% (n = 13,963), and its administration was associated with increased odds for POD (odds ratio, 1.85; 95% confidence interval [CI], 1.60-2.13), a small higher average pain score on day 3 (mean difference, 0.08; 95% CI, 0.02-0.14), increased odds for postoperative intubation/reintubation (odds ratio, 1.29; 95% CI, 1.12-1.48), and a small lower average pain score at discharge (mean difference, –0.31; 95% CI, –0.21 to–0.41). Postoperative dexmedetomidine was associated with a small higher average pain score at discharge (mean difference, 0.27; 95% CI, 0.21-0.34) and higher odds for 30-day mortality (odds ratio, 1.25, 95% CI, 1.07-1.46). Conclusions: In this registry of cardiac surgical patients dexmedetomidine administration was associated with POD and adverse outcomes.