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Updated: Jan 15, 2026
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
Intraoperative high dose dexamethasone is associated with clinically relevant postoperative pancreatic fistula: a
Scott C Fligor1, John Christopher Polanco-Santana1, Ashley Lanys1
1Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Background:
Intraoperative dexamethasone is routinely administered to prevent postoperative nausea and vomiting. Limited research has investigated dexamethasone safety during pancreatectomy. We investigated whether intraoperative dexamethasone administration affects clinically relevant postoperative pancreatic fistula (CR-POPF) development.
Methods:
We performed a retrospective cohort study of patients undergoing pancreatoduodenectomy or distal pancreatectomy at a single academic institution (2014-2021). Impact of dexamethasone administration on CR-POPF (ISGPF Grade B/C) was assessed using multivariable logistic regression and inverse probability weighted regression analysis.
Results:
503 patients were included (pancreatoduodenectomy n=307; distal pancreatectomy n=196). Of these, 59 (11.7%) received low-dose dexamethasone (4-6 mg) and 100 (19.9%) received high-dose dexamethasone (8-10 mg). High dose dexamethasone (aOR:2.47, 95% CI:1.40-4.36), but not low dose dexamethasone (aOR:1.32, 95% CI:0.61-2.86), was associated with increased odds of CR-POPF. After inverse probability weighted regression adjustment, the average treatment effect of high dose dexamethasone on CR-POPF was +11.1% (95% CI:1.7-20.3%) above the baseline risk of 12.5% (95% CI:9.0-16.1%) in patients receiving no dexamethasone.
Discussion:
Intraoperative administration of high dose (8-10mg) dexamethasone was associated with a meaningfully increased risk of CR-POPF after pancreatectomy. High-dose dexamethasone is a modifiable risk factor for CR-POPF and should be avoided unless there is clear clinical indication.
