In summary, the routine use of prophylactic steroids is not indicated for patients undergoing cardiac surgery. However, a subgroup analysis of the Dexamethasone for Cardiac Surgery trial demonstrated an interaction according to age, suggesting that patients younger than 65 years may benefit from the preoperative use of steroids [203]. Indeed, younger patients generally have a more pronounced inflammatory response than elderly patients; therefore, suppression of this effect with steroids could have a potential benefit. Patients on chronic steroid therapy should receive their usual preoperative dose of steroids on the day of the operation. Additional perioperative stress–dose steroids for these patients are reasonable but are not evidence-based [204].
