An individual patient meta-analysis of clinical trials using dopexamine to increase oxygen delivery in high-risk surgical patients

Introduction

Postoperative outcomes may be improved if cardiac output and oxygen delivery are maintained at optimal levels. Trials of the use of dopexamine for this purpose have yielded inconsistent results. This may relate to the use of high doses in some trials. A meta-analysis of data from these trials may therefore identify a benefit of low-dose dopexamine on postoperative mortality and length of stay.

Methods

A comprehensive literature review was performed to identify published randomised trials of perioperative dopexamine infusion in patients undergoing major surgery. Individual patient data were obtained, allowing a meta-regression approach to explore mortality outcomes after correction for age and dose of dopexamine. A Cox proportional hazards model was constructed to examine the length of stay.

Results

Five studies fulfilled the inclusion criteria [1–5]. Low-dose dopexamine (≤1 μg/kg/min) was associated with a 49% reduction in 28-day mortality (6.3% vs 12.3%; OR = 0.51 (95% CI 0.29–0.89), P = 0.008). The length of postoperative stay was also reduced in the low-dose dopexamine group compared with control (median 13 vs 15 days, HR 0.75 (95% CI 0.65–0.88), P = 0.004). High-dose dopexamine (>1 μg/kg/min) was not associated with a difference in mortality (14.5% vs 12.3%; OR = 1.18 (95% CI 0.67–2.08), P = 0.37) or length of stay (median 17 vs 15 days, HR 1.10 (95% CI 0.90–1.34), P = 0.37) when compared with controls.

Conclusion

Perioperative use of low-dose dopexamine decreases mortality and duration of hospital stay in patients undergoing major surgery.