ArticleJournal of anesthesia2026
The effect of intravenous low-dose steroids on post-operative delirium in older adult patients undergoing non-cardiac surgery: a retrospective cohort analysis.
Article in Journal of anesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
purposePostoperative 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.
methodsWe 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.
resultsAmong 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).
conclusionsIntraoperative 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.
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