Journal of cardiothoracic and vascular anesthesia · 2025
Combined Propofol and Dexmedetomidine Is Associated with Lower Mortality but Not Delirium After Cardiovascular Surgery: A Retrospective Cohort Study Using an Administrative Claims Database.
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Tamoto Mitsuhiro, Kai Shinichi, Yoshida Hisako, Shintani Ayumi
Аннотация
OBJECTIVES: To compare the real-world effectiveness of combined propofol and dexmedetomidine (PRODEX) sedation with propofol monotherapy on survival and postoperative delirium (POD) in a large nationwide cohort of patients undergoing cardiovascular surgery.
DESIGN: A retrospective cohort study.
SETTING: Data from a Japanese nationwide administrative claims database, including more than 400 acute care hospitals.
PARTICIPANTS: There were 23,629 patients, including 9,671 PRODEX users and 13,958 propofol users.
INTERVENTION: None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was 28-day mortality. The secondary outcomes were 90-day mortality and POD incidence. PRODEX users were associated with lower 28-day mortality (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.63-0.93; p < 0.01) and 90-day mortality (HR 0.82; 95% CI 0.69-0.96; p = 0.01) compared with propofol users. The Fine and Gray model showed no significant difference in the POD risk between PRODEX users and propofol users (subdistribution HR, 1.01; 95% CI 0.94-1.08; p = 0.81).
CONCLUSIONS: This large-scale, real-world study found that PRODEX was associated with a significant decrease in 28- and 90-day mortality. However, PRODEX did not reduce the incidence of POD compared to propofol monotherapy.
DESIGN: A retrospective cohort study.
SETTING: Data from a Japanese nationwide administrative claims database, including more than 400 acute care hospitals.
PARTICIPANTS: There were 23,629 patients, including 9,671 PRODEX users and 13,958 propofol users.
INTERVENTION: None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was 28-day mortality. The secondary outcomes were 90-day mortality and POD incidence. PRODEX users were associated with lower 28-day mortality (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.63-0.93; p < 0.01) and 90-day mortality (HR 0.82; 95% CI 0.69-0.96; p = 0.01) compared with propofol users. The Fine and Gray model showed no significant difference in the POD risk between PRODEX users and propofol users (subdistribution HR, 1.01; 95% CI 0.94-1.08; p = 0.81).
CONCLUSIONS: This large-scale, real-world study found that PRODEX was associated with a significant decrease in 28- and 90-day mortality. However, PRODEX did not reduce the incidence of POD compared to propofol monotherapy.