2025 Southeastern Residency Conference

Title: Effect of Steroids on Post Cardiac Surgery Length of Stay 


Authors: Emily-Kate Carter, Krista Riche, and Jamie Wagner


Background: Steroids can be used for patients undergoing surgery to decrease inflammation that arises due to the trauma and stress of surgery, and they can be useful antiemetics in some patients. Additionally, steroids have been proposed to have many benefits in patients just having undergone surgery such as decreased length of stay, decreased pulmonary complications, decreased infection risk, and a decreased risk of post-cardiac surgery new onset atrial fibrillation (AFib). The benefit of steroids, specifically for post-operative AFib risk reduction, seems to be due to the decrease in C-reactive protein, white blood cell count, and inflammatory cytokines following steroid administration. However, using steroids is a known risk factor for hyperglycemia, and therefore increases insulin demand in post-operative patients. Studies show that post-operative hyperglycemia increases the risk of mortality in cardiac surgery patients with and without diabetes. The purpose of our study is to determine if administering steroids after cardiac surgery has an effect on patients’ length of stay.


Methods: This single-center, retrospective group pretest/posttest quasi-experiment included patients admitted to St. Dominic Jackson-Memorial Hospital from June 01, 2023 to December 31, 2023, when steroids were not given to patients post-surgery, and June 01, 2024 to December 31, 2024, when steroids began to be given, who were aged ≥18 years, undergoing major cardiac surgeries, including Coronary artery bypass graft (CABG), Aortic Valve Replacement (AVR), Mitral Valve Replacement (MVR), or Tricuspid Valve Replacement (TVR). Patients were excluded if an Impella device was utilized peri-operatively, if they were treated with antibiotics for known or suspected infection before surgery, or if they died within 48 hours of the surgery. The primary outcome is length of post cardiac surgery ICU stay in hours. Secondary outcomes include total length of post-cardiac surgery hospital stay in hours, prevalence of hyperglycemia within 72-hours post-operation, and prevalence of post-operative-infections within 30 days.


Results: A total of 100 patients were enrolled in this study, with 50 in the steroids group and 50 in the control group. Average length of stay in the ICU was similar in both groups at 88.28 ± 137.30 hours in the control group vs 92.04 ± 137.57 hours in the steroid group (p = 0.89). There was also no statistical difference in total hospital length of stay at 201.08 ± 189.09 hours for the control group vs 193.62 ± 130.84 hours for the steroid group (p= 0.82). The prevalence of hyperglycemia within 72 hours did not differ between the control group with 66% (n=33) and the steroids group with 68% (n=34). No post-operative deep sternal wound infections were observed in either group within 30 days. The only statistically significant finding was a lower rate of post-operative atrial fibrillation (AF) in the steroid group of 14% (n=7) compared to the control group with 48% (n=24) (p= <0.01).


Conclusions: Utilization of post-operative steroids did not impact ICU length of stay or total hospital length of stay. There was not a statistically significant difference in the prevalence of hyperglycemia or deep sternal wound infections between the groups. Post-operative AF occurrence was significantly lower in the steroid group compared to the control group.