Impact of perioperative dexamethasone on postoperative complications in diabetic patients undergoing spine surgery

Dexamethasone is commonly used perioperatively for analgesic and antiemetic benefit, however, the risk of postoperative hyperglycemia is concerning, particularly among diabetic patients undergoing spine surgery, where extensive tissue exposure and hardware implantation may increase risk of wound complications. The influence of baseline glycemic control and surgical approach on dexamethasone-associated risk remains poorly characterized.

A retrospective cohort study using the TriNetX United States Collaborative Network, a nationally representative database comprised of over 117 million unique patients, was conducted. Adults with diabetes mellitus who underwent spine surgery between 2014 and 2024 were identified and categorized into anterior cervical, posterior cervical, lumbar decompression, and lumbar decompression with fusion groups. Patients receiving perioperative dexamethasone were compared with matched controls who did not receive dexamethasone using 1:1 propensity score matching. Patients were stratified by preoperative hemoglobin A1c (<7.5%, 7.5%-8.9%, ≥9.0%). Ninety-day postoperative outcomes included hyperglycemia, wound complications, infection, sepsis, cardiopulmonary events, renal failure, transfusion, and mortality.

Among 154,469 patients with diabetes who underwent spine surgery during the study period, dexamethasone administration was associated with higher odds of postoperative hyperglycemia, wound dehiscence, wound infection, sepsis, acute kidney injury, transfusion, and respiratory failure. Effects varied by approach. In cervical procedures, dexamethasone increased hyperglycemia but was associated with lower rates of pneumonia, respiratory failure, and mortality. In lumbar procedures, dexamethasone was associated with increased wound infection, myocardial infarction, and transfusion risk. Glycemic control was found to be a significant risk modifier with increased risk of postoperative complications associated with increasing A1c.

Perioperative dexamethasone administration is associated with increased hyperglycemia and wound complications in diabetic patients undergoing spine surgery, with the highest risk in those with poor preoperative glycemic control and in lumbar procedures. These findings support dexamethasone administration tailored to surgical approach and preoperative A1c for diabetic patients undergoing spine surgery.