Perioperative Medicine  |   February 2017
Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial: A Randomized, Double-blind, Placebo-controlled Substudy
Author Notes
  • From the Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia (C.F.R., J.O.-Y., A.R.); Department of Anaesthesia and Pain Management (C.F.R.) and Department of Cardiothoracic Surgery (A.R.), The Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (L.S., A.K., A.A., K.P.D.I.S.); Department of Surgery (R.W., P.J.D.), Population Health Research Institute (R.W., J.V., P.J.D.), Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; and Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand (K.P.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication May 20, 2016. Accepted for publication October 6, 2016.
    Submitted for publication May 20, 2016. Accepted for publication October 6, 2016.×
  • Address correspondence to Dr. Royse: Department of Surgery, Level 6 Clinical Medical Research Building, The Royal Melbourne Hospital, PO Box 2135, RMH, Melbourne, Victoria 3050, Australia. colin.royse@unimelb.edu.au. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Central and Peripheral Nervous Systems
Perioperative Medicine   |   February 2017
Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial: A Randomized, Double-blind, Placebo-controlled Substudy
Anesthesiology 2 2017, Vol.126, 223-233. doi:10.1097/ALN.0000000000001433
Anesthesiology 2 2017, Vol.126, 223-233. doi:10.1097/ALN.0000000000001433
Abstract

Background: Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery.

Methods: Five hundred fifty-five adults from three hospitals enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial were randomly allocated to placebo or 250 mg methylprednisolone at induction and 250 mg methylprednisolone before cardiopulmonary bypass. Each completed the Postoperative Quality of Recovery Scale before surgery and on days 1, 2, and 3 and 1 and 6 months after surgery and the Confusion Assessment Method scale for delirium on days 1, 2, and 3. Recovery was defined as returning to preoperative values or improvement at each time point.

Results: Four hundred eighty-two participants for recovery and 498 participants for delirium were available for analysis. The quality of recovery improved over time but without differences between groups in the primary endpoint of overall recovery (odds ratio range over individual time points for methylprednisolone, 0.39 to 1.45; 95% CI, 0.08–2.04 to 0.40–5.27; P = 0.943) or individual recovery domains (all P > 0.05). The incidence of delirium was 10% (control) versus 8% (methylprednisolone; P = 0.357), with no differences in delirium subdomains (all P > 0.05). In participants with normal (51%) and low baseline cognition (49%), there were no significant differences favoring methylprednisolone in any domain (all P > 0.05). Recovery was worse in patients with postoperative delirium in the cognitive (P = 0.004) and physiologic (P < 0.001) domains.

Conclusions: High-dose intraoperative methylprednisolone neither reduces delirium nor improves the quality of recovery in high-risk cardiac surgical patients.