Letter From Tripathi et al Regarding Article, “Perioperative Dexmedetomidine Improves Outcomes of Cardiac Surgery”

In a recent issue of Circulation , Ji and colleagues1 report improved morbidity and mortality with perioperative use of dexmedetomidine in cardiac surgery. We commend the authors for exploring the benefits of dexmedetomidine on outcomes despite drug cost. The mortality benefits at in-hospital, 30-day, and 1-year points are notable. Although outcomes were risk adjusted, the patients who received dexmedetomidine had significantly shorter cardiopulmonary bypass duration (181.8 vs 199.8 minutes) and lower incidence of intra-aortic balloon pump requirement (6.87% vs 14.13%). The multivariate model assessing delirium did not include cardiopulmonary bypass duration, yet longer durations are associated with an increase in postoperative delirium.2 Furthermore, the multivariate model assessing mortality did not …