Low-dose dexamethasone during arthroplasty: What do we know about the risks?

Area of Science:

• Orthopaedic Surgery
• Anesthesiology
• Pharmacology

Background:

• Dexamethasone is frequently used in arthroplasty to manage post-operative nausea and vomiting (PONV).
• Concerns exist among orthopaedic surgeons and anesthesiologists regarding potential risks of impaired wound healing and surgical site infections (SSI) associated with dexamethasone use.
• Conflicting views necessitate a clear understanding of the safety profile of peri-operative dexamethasone in hip and knee arthroplasty.

Purpose of the Study:

• To systematically review the existing evidence on the safety of a single, low dose of dexamethasone administered peri-operatively in patients undergoing hip and knee arthroplasty.
• To evaluate the association between low-dose peri-operative dexamethasone and the incidence of surgical site infections (SSI) and wound healing impairment.

Main Methods:

• A systematic literature search was conducted across PubMed, EMBASE, and Cochrane databases, including cited references, from 1980 to 2013.
• Studies were selected based on predefined inclusion criteria, focusing on peri-operative single low-dose dexamethasone in hip and knee arthroplasty.
• A qualitative review and 'pro' and 'con' discussion were employed to synthesize findings from the included studies.

Main Results:

• Eight studies, involving a total of 1335 patients, met the inclusion criteria; none reported an incidence of SSI.
• While dexamethasone can induce hyperglycemia, no studies demonstrated a link between its use and SSI.
• Animal studies suggest high-dose dexamethasone may inhibit wound healing, but evidence for low-dose peri-operative use in humans is lacking.

Conclusions:

• Current studies do not provide evidence that a single low dose of dexamethasone contributes to SSI or impairs wound healing in arthroplasty patients.
• Significant statistical power to draw definitive conclusions on safety requires a much larger sample size (27,205 patients).
• A collaborative approach between anesthesiologists and orthopaedic surgeons is crucial to balance the risk-benefit ratio of peri-operative steroid use.