Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery: a randomised trial

Anaesthesia. 2017 Jun;72(6):704-713. doi: 10.1111/anae.13853. Epub 2017 Mar 20.


Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra-operative dose of dexamethasone 1 mg.kg-1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12-month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £-1672 to -137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality-adjusted life year. We conclude that intra-operative high-dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.

Keywords: cost effectiveness; dexamethasone; inflammation; surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / economics*
  • Anti-Inflammatory Agents / therapeutic use*
  • Cardiac Surgical Procedures / methods*
  • Cost-Benefit Analysis
  • Dexamethasone / administration & dosage
  • Dexamethasone / economics*
  • Dexamethasone / therapeutic use*
  • Double-Blind Method
  • Female
  • Humans
  • Incidence
  • Intraoperative Period
  • Length of Stay
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / prevention & control
  • Quality-Adjusted Life Years
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / prevention & control
  • Survival Analysis
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Dexamethasone