The effect of intravenous low-dose steroids on post-operative delirium in older adult patients undergoing non-cardiac surgery: a retrospective cohort analysis.

PURPOSE: Postoperative delirium (POD) is a common complication in elderly surgical patients, associated with increased mortality and healthcare costs. While high-dose steroids may reduce POD risk in non-cardiac surgeries, infection concerns limit their use. This study assessed whether intraoperative low-dose steroids, commonly used as antiemetics, are associated with lower POD incidence.

METHODS

We conducted a retrospective cohort study of patients aged 65 or older who underwent elective non-cardiac surgery at Cleveland Clinic from 2016 to 2024. Patients receiving intraoperative steroids (4-10 mg dexamethasone) were compared to those who did not. Primary outcome was POD within 4 days postoperatively; secondary outcomes included hospital length of stay and infection complications. Logistic and linear regression models were used and adjusted for potential confounders. Additionally, a sensitivity analysis was conducted to examine the interaction between steroids and dementia.

RESULTS

Among 46,966 patients, 59% received steroids. POD incidence was significantly lower in the steroid administration group (0.6%) versus controls (2.2%) [adjusted odds ratio (aOR): 0.33, 95% confidence interval (CI): 0.25-0.42, P < 0.001], a finding that remained consistent under broader POD definitions (5.1% vs. 8.9%; aOR = 0.76, 95% CI 0.69-0.84, P < 0.001). The benefit was evident in patients without dementia (aOR: 0.73) but not in those with dementia (aOR: 1.18). Steroid administration was also linked to shorter hospital stays (adjusted geometric mean ratio: 0.90, P < 0.001) and fewer postoperative infections (aOR: 0.43, P < 0.001).

CONCLUSIONS

Intraoperative steroid administration was associated with reduced POD, shorter hospital stays, and fewer infections in elderly patients undergoing elective non-cardiac surgery. These findings support their perioperative use, particularly in patients without preexisting dementia.