| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
| non-cardiac major surgery | 
 
 
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| E.1.1.1 | Medical condition in easily understood language  | 
| non-cardiac major surgery | 
 
 
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| E.1.1.2 | Therapeutic area  | Not possible to specify | 
| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 20.0 | 
 
| E.1.2 | Level  | PT | 
 
| E.1.2 | Classification code  | 10042609 | 
 
| E.1.2 | Term  | Surgery | 
 
| E.1.2 | System Organ Class  | 10042613 - Surgical and medical procedures | 
 
 
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| E.1.3 | Condition being studied is a rare disease  |  No  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
| Evaluate the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery | 
 
 
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| E.2.2 | Secondary objectives of the trial  | 
-	To evaluate the safety (clinical adverse events, especially glycaemic deregulation) of corticosteroids administration in patients undergoing major non-cardiac surgery -	To evaluate the effect of corticosteroid administration on the incidence of postoperative infections, wound healing -	To evaluate the effect of corticosteroid administration on postoperative gastrointestinal dysfunction -	To evaluate the effect of corticosteroid administration on the duration of hospital stay 
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| E.2.3 | Trial contains a sub-study  |  No  | 
| E.3 | Principal inclusion criteria  | 
Major surgery (> 90 minutes and realized under general anesthesia) of the abdomen, pelvis, thorax, face/neck, vascular surgery in a patient older than 65 years Or  Major surgery (> 90 minutes and realized under general anesthesia) of the abdomen, pelvis, thorax, face/neck, vascular surgery in a patient older than 50 years and presenting one of the following criteria o	Presence of a defined risk factor for cardiac or respiratory disease (exercise tolerance equivalent to 6 metabolic equivalents or less) o	Medical history of stroke o	Moderate to severe renal impairment (clearance of creatinine ≤ 30 mll/L) o	Active smoking o	Averaged observed blood losses over 500 ml o	Emergency surgery 
 
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| E.4 | Principal exclusion criteria | 
-	Pregnant women, Minors, Adults under guardianship or trusteeship  -	Treatment with systemic corticosteroids at a dose > 5 mg.day-1 of equivalent prednisolone in the previous 3 months  -	Patients with chronic renal failure (clearance of creatinine < 10 ml/min) -	Patients for which death is deemed imminent and inevitable or patients with an underlying disease process with a life expectancy of less than 1 month -	Patient with preoperative shock (defined by the need for vasoactive drugs before surgery) -	Acute Pulmonary edema in the last 7 days -	Active bacterial or viral infection -	Allergy to the intravenous formulation of dexamethasone -	Uncontrolled psychotic disorder (acute or chronical)  
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| E.5 End points | 
| E.5.1 | Primary end point(s) | 
Composite outcome (all-cause mortality and major postoperative complications) within 14 days after surgery, at least one item among the following: -	Postoperative sepsis, severe sepsis, septic shock -	Postoperative pulmonary complication (postoperative pneumonia, need for invasive ventilation and/or noninvasive ventilation for respiratory failure) 
 
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| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
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| E.5.2 | Secondary end point(s) | 
-	All-cause mortality 28 days after randomization -	Hospital free-days at 28 days  -	Surgical complications according to the Clavien-Dindo classification within 28 days following randomization -	Duration of hospital stay (patients who will be outside the hospital but in other types of health care facilities at day 28 will be considered to have been discharged home) -	Unplanned admission or readmission to critical care (within 28 days following randomization) -	Proportion of patients who experience postoperative morbidity (all defined according to consensus criteria or universal definitions within 7 days after surgery) including: o	renal dysfunction (according to the KDIGO criteria: Appendix 2), o	cardiac complications (acute heart failure, myocardial infarction),  o	infectious complications (especially surgical site infection),  o	gastrointestinal dysfunction -	Duration of invasive mechanical ventilation, Duration of non-invasive mechanical ventilation -	SOFA score at day 1 and day 3 after surgery -	Percentage of patients with new organ dysfunction (not present at randomization) -	Blood levels of CRP -	Proportion of patients who experienced adverse events, especially hyperglycaemia, healing impairment within 7 days after surgery 
 
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| E.5.2.1 | Timepoint(s) of evaluation of this end point | 
 | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis |  No  | 
| E.6.2 | Prophylaxis |  Yes  | 
| E.6.3 | Therapy |  Yes  | 
| E.6.4 | Safety |  No  | 
| E.6.5 | Efficacy |  Yes  | 
| E.6.6 | Pharmacokinetic |  No  | 
| E.6.7 | Pharmacodynamic |  No  | 
| E.6.8 | Bioequivalence |  No  | 
| E.6.9 | Dose response |  No  | 
| E.6.10 | Pharmacogenetic |  No  | 
| E.6.11 | Pharmacogenomic |  No  | 
| E.6.12 | Pharmacoeconomic |  No  | 
| E.6.13 | Others |  No  | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) |  No  | 
| E.7.1.1 | First administration to humans |  No  | 
| E.7.1.2 | Bioequivalence study |  No  | 
| E.7.1.3 | Other |  No  | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) |  No  | 
| E.7.3 | Therapeutic confirmatory (Phase III) |  Yes  | 
| E.7.4 | Therapeutic use (Phase IV) |  No  | 
| E.8 Design of the trial | 
| E.8.1 | Controlled |  Yes  | 
| E.8.1.1 | Randomised |  Yes  | 
| E.8.1.2 | Open |  No  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  Yes  | 
| E.8.1.5 | Parallel group |  No  | 
| E.8.1.6 | Cross over  |  Yes  | 
| E.8.1.7 | Other |  Yes  | 
| E.8.1.7.1 | Other trial design description | 
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| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  No  | 
| E.8.2.2 | Placebo  |  Yes  | 
| E.8.2.3 | Other |  No  | 
| E.8.2.4 | Number of treatment arms in the trial | 2 | 
| E.8.3 | 
                                The trial involves single site in the Member State concerned
                             |  No  | 
| E.8.4 |  The trial involves multiple sites in the Member State concerned  |  Yes  | 
| E.8.4.1 | Number of sites anticipated in Member State concerned | 32 | 
| E.8.5 | The trial involves multiple Member States |  No  | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA |  No  | 
| E.8.6.2 | Trial being conducted completely outside of the EEA |  No  | 
| E.8.7 | Trial has a data monitoring committee |  Yes  | 
| E.8.8 | 
                        Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial
                     | 
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| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years |  | 
| E.8.9.1 | In the Member State concerned months | 25 | 
| E.8.9.1 | In the Member State concerned days |  |