Three Perioperative Interventions Do Not Affect Quality of Life


Anesthesiology_January2San Francisco—The administration of steroids in the perioperative period, tight glucose control during surgery and light anesthesia do not affect patient quality of life measured at 30 days after major noncardiac surgery, a new study shows.

Although previous studies have found an association between steroids and improved quality of life (QoL) after cardiac surgery, results of the DeLiT (Dexamethasone, Light Anaesthesia, and Tight Glucose Control) randomized controlled trial failed to support those results. Also of note, this is the first and only randomized trial to date to study tight versus conventional glucose control in noncardiac surgery patients.

“Initially, investigators were under the impression that tight glucose control is beneficial,” said Basem Abdelmalak, MD, associate professor of anesthesiology and director of anesthesia for bronchoscopic surgery at Cleveland Clinic in Ohio. “Dexamethasone is currently being used for postoperative nausea and vomiting prophylaxis, or to help decrease airway edema in airway surgery.” However, this study did not show either intervention to be beneficial. Dr. Abdelmalak presented the results of his team’s study at the 2013 annual meeting of the American Society of Anesthesiologists (ASA; abstract 4168).

Previous work indicates that high-dose steroids improve QoL after cardiac surgery; it also indicates that intensive glucose control reduces sepsis and improves mortality outcomes in some patient populations, according to the researchers. Anesthesia guided by bispectral index monitoring (BIS; Covidien) reportedly speeds recovery and reduces respiratory complications as well as nausea and vomiting. The investigators thus expected to demonstrate beneficial effects of each tested intervention, Dr. Abdelmalak said.

The study consisted of 326 patients scheduled for noncardiac surgery under general anesthesia. They were randomized to receive 14 mg of IV dexamethasone tapered over three days versus placebo, intensive versus conventional glucose control (blood sugar goal of 80-110 mg/dL vs. 180-200 mg/dL), and light (BIS target 55) versus deep anesthesia (BIS target 35).

The researchers assessed QoL using the SF-12v2 Health Survey, a shorter version of the SF-36v2, obtaining scores preoperatively and 30 days after surgery. The researchers evaluated the effect of each intervention on physical and mental components of the survey.

After adjusting for minor differences in baseline ASA physical status, type of surgery and history of congestive heart failure and coronary artery disease, the researchers found no difference for any intervention on physical or mental SF-12v2 scores 30 days after surgery (P>0.4 for all).

Quality of life was a secondary outcome for DeLiT. The recently published primary results of the study, based on a composite of serious complications, showed no significant effect on perioperative morbidity from any of the three treatments (Table; Br J Anaesth 2013;111:209-221).

“Given that none of the interventions influenced the primary outcome, it is perhaps unsurprising that there was also no effect on quality of life. It remains possible, though, that a larger dose of steroid may yet prove effective,” said Daniel I. Sessler, MD, the senior investigator on the study and director of outcomes research at the institution.

“There is increasing interest in quality of life as a primary or secondary end point in large perioperative trials, as researchers realize that survival is not the only outcome that is valued by patients and their carers,” said Kate Leslie, professor and head of Anaesthesia Research at the Royal Melbourne Hospital in Melbourne, Australia, who was not involved in the work. “The investigators tested three perioperative interventions with the potential to improve quality of life after surgery. Although none were shown to improve quality of life, these data provide a suitable basis for further study of different doses of dexamethasone and other anti-inflammatory treatments.”





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