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THE EFFECTS OF PERIOPERATIVE DEXAMETHASONE ON GLYCEMIC CONTROL AND POSTOPERATIVE OUTCOMES.

Rebecca A Herbst, Onala T Telford, John Hunting

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    |October 26, 2019
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    Summary

    Perioperative dexamethasone use in orthopedic surgery patients temporarily increases blood glucose but shortens hospital stays. It also improves 90-day survival for patients without diabetes mellitus (DM).

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    Area of Science:

    • Anesthesiology and Perioperative Medicine
    • Endocrinology and Metabolism
    • Surgical Outcomes Research

    Background:

    • Perioperative glucocorticoids like dexamethasone are common for pain and nausea management.
    • The impact of perioperative steroids on glycemic control, length of stay (LOS), and survival requires systematic evaluation.
    • Understanding these effects is crucial for optimizing patient care, especially for those with diabetes mellitus (DM).

    Purpose of the Study:

    • To investigate the association between perioperative dexamethasone and postoperative blood glucose levels.
    • To evaluate the impact of dexamethasone on hospital length of stay (LOS), readmission rates, and 90-day survival in orthopedic surgery patients.
    • To compare outcomes between patients with and without diabetes mellitus (DM).

    Main Methods:

    • Retrospective analysis of 4,800 orthopedic surgery patients (2000-2016).
    • Comparison of outcomes (hyperglycemia, LOS, readmission, survival) between patients receiving a single dose of dexamethasone and those who did not.
    • Stratified analysis for patients with and without diabetes mellitus (DM).

    Main Results:

    • Dexamethasone was associated with higher rates of hyperglycemia within 24 hours post-surgery in both DM and non-DM cohorts (HR 1.81 and 2.34, respectively).
    • Patients receiving dexamethasone had a shorter LOS by nearly 1 day (GMR 0.79 for DM, 0.75 for non-DM).
    • No significant difference in 90-day readmission rates; however, non-DM patients receiving dexamethasone showed improved 90-day survival (99.07% vs. 96.90%).

    Conclusions:

    • Perioperative dexamethasone in orthopedic surgery is linked to transient hyperglycemia but offers benefits.
    • Dexamethasone use is associated with reduced hospital length of stay (LOS) for both diabetic and non-diabetic patients.
    • Dexamethasone improves 90-day survival in non-diabetic patients, suggesting a favorable risk-benefit profile in specific populations.