Abstract 1904: Improved Post-Operative Outcomes Are Associated With the Use of Perioperative Steroids for High-Risk Pediatric Cardiac Surgery
Steroids are commonly used with the aim to reduce morbidity associated with cardiopulmonary bypass-induced inflammation after pediatric cardiac surgery, but outcomes are not well defined. A non-randomized comparison was undertaken of 253 consecutive pediatric cardiac surgeries requiring cardiopulmonary bypass with an Aristotle score >10. Patients admitted the day before surgery received 10 mg/kg in the evening before surgery, an additional 10 mg/kg the morning of surgery and 30 mg/kg in the pump prime. Patients admitted the day of surgery received 30 mg/kg in the operating room. To account for non-random assignment of perioperative steroid use, a propensity model was created to establish each individual patient’s probability of receiving steroids (~150 variables evaluated, final model 16 variables, c-stat 0.94, p<0.001). Associations between post-operative outcomes and steroid use were estimated in multivariable linear regression models adjusted for previous surgeries, age at operation, cardiopulmonary bypass and aortic cross-clamp times, use of deep hypothermic circulatory arrest, surgeon, baseline O2 saturation, total heparin dose and antifibrinolytic use. Regression models were then adjusted further with the propensity score and the use of preoperative steroids. A total of 138 (55%) patients received perioperative steroids; 46 (18%) also received preoperative doses. In multivariable linear regression models adjusted for potential confounders and propensity score, use of perioperative steroids was associated with shorter duration of ventilation (EST: −0.258 log days (0.089), p=0.004), and reductions in length of ICU (EST: −0.382 log days (0.042), p<0.001) and hospital stay (EST: −0.272 (0.036) log days, p<0.001). Additional improvements were noted with preoperative administration. Steroid use was not associated with need for early reoperation or in-hospital mortality. Perioperative steroid use is associated with improved post-operative outcomes for children undergoing cardiac surgery, with an additive benefit associated with use of an initial preoperative dose. Confirmation of these results in large scale clinical trials is necessary.