- Design
- Post hoc analysis of two randomised trials, inverse probability weighting, 30 hospitals
- Population
- 1,963 adults having major abdominal or thoracic surgery
- Primary outcome
- Postoperative pulmonary complications within 30 days
- Effect
- Weighted OR 0.86 (0.62-1.18); PaO2/FiO2 +19.9 mmHg (0.64-39.1)
This post hoc analysis of two iPROVE ventilation trials across 30 hospitals included 1,963 adults having major abdominal or thoracic surgery. Patients given intraoperative corticosteroids at antiemetic doses were compared with those not given them, using inverse probability weighting.
Unadjusted, severe pulmonary complications were lower with steroids (9.3% vs 14.0%). After weighting, the association disappeared (OR 0.86, 95% CI 0.62-1.18). PaO2/FiO2 in recovery was modestly higher (adjusted mean difference 19.9 mmHg, 0.64-39.1).
The crude difference is a reminder of how confounded steroid use is: sicker and higher-risk patients are less likely to receive them. Once that is accounted for, there is no clear lung benefit.
Dexamethasone remains justified for nausea prophylaxis; it should not be given in the expectation of preventing pulmonary complications.
- Give dexamethasone for PONV prophylaxis on its own merits.
- Do not count on it to prevent postoperative pulmonary complications.
- Focus pulmonary prevention on proven measures: protective ventilation, analgesia, early mobilisation.
- Check glucose after steroids in patients with diabetes.
Why it matters
A plausible side benefit of a near-universal drug did not survive adjustment for who receives it.
Don't overread it
This was an observational analysis within trials; a small benefit cannot be excluded, and the oxygenation gain is of uncertain clinical meaning.
The statistics, in plain English
The unadjusted difference shrank after weighting because patients given steroids were healthier at baseline. An odds ratio of 0.86 with an interval crossing 1.0 means anything from a 38% reduction to an 18% increase is compatible with the data.
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