- Design
- Post hoc weighted analysis of two randomised trials
- Population
- 1,963 adults having major abdominal or thoracic surgery in 30 hospitals
- Primary outcome
- Postoperative pulmonary complications within 30 days
- Effect
- OR 0.86 (95% CI 0.62 to 1.18) after weighting
This post hoc analysis of two iPROVE trials across 30 hospitals included 1,963 adults having major abdominal or thoracic surgery. Patients who received intraoperative corticosteroids, at antiemetic doses, were weighted against those who did not using preoperative confounders.
Unweighted, severe pulmonary complications were lower with steroids (9.3% vs 14.0%). After weighting, the association disappeared (OR 0.86, 95% CI 0.62 to 1.18). The PaO2/FiO2 ratio in recovery was about 20 mmHg higher with steroids (0.64 to 39.1).
The crude difference reflected who received steroids, not what steroids did. Dexamethasone remains appropriate for nausea prophylaxis, but pulmonary protection is not a reason to give it.
- Continue dexamethasone for PONV prophylaxis where indicated.
- Do not add steroids expecting fewer pulmonary complications.
- Focus pulmonary risk reduction on ventilation strategy, analgesia and early mobilisation.
- Watch glucose in patients with diabetes who receive dexamethasone.
Why it matters
It removes a hoped-for secondary benefit that some teams cite when giving steroids routinely.
Don't overread it
A post hoc observational analysis — it cannot exclude a small benefit or harm.
The statistics, in plain English
The crude 4.7-point difference vanished once groups were balanced, a classic sign of confounding. An OR of 0.86 with an interval from 0.62 to 1.18 fits both a modest benefit and a modest harm.
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