Dexamethasone and Surgical-Site Infection

Area of Science:

• Anesthesiology and Perioperative Medicine
• Infectious Disease Epidemiology
• Clinical Pharmacology

Background:

• Glucocorticoids like dexamethasone are used to prevent postoperative nausea and vomiting.
• Concerns exist regarding dexamethasone potentially increasing surgical-site infection (SSI) risk.

Purpose of the Study:

• To evaluate if dexamethasone is noninferior to placebo in preventing SSIs.
• To assess the efficacy of dexamethasone in reducing postoperative nausea and vomiting.

Main Methods:

• A pragmatic, international, noninferiority trial involving 8880 adult patients undergoing nonurgent, noncardiac surgery.
• Patients received either intravenous dexamethasone (8 mg) or placebo under anesthesia.
• The primary outcome was SSI within 30 days; secondary outcomes included postoperative nausea and vomiting.

Main Results:

• Dexamethasone was noninferior to placebo for SSI incidence (8.1% vs. 9.1%; adjusted risk difference -0.9 percentage points).
• Postoperative nausea and vomiting occurred less frequently with dexamethasone (42.2% vs. 53.9%).
• Hyperglycemic events were rare in patients without diabetes (0.6% vs. 0.2%).

Conclusions:

• Dexamethasone is noninferior to placebo for preventing surgical-site infections in this patient population.
• Dexamethasone significantly reduces postoperative nausea and vomiting.
• The findings support the use of dexamethasone for managing postoperative nausea and vomiting while maintaining surgical site safety.