Timing of Dexamethasone Administration for Gynecological Laparoscopy Under Enhanced Recovery After Surgery: A Retrospective Cohort Study

Postoperative nausea and vomiting (PONV) remains a major barrier to implementing Enhanced Recovery After Surgery (ERAS) pathways in gynecological laparoscopy, while perioperative inflammation may delay postoperative recovery. The optimal timing of dexamethasone administration for PONV prophylaxis and attenuation of inflammatory responses remains uncertain. This retrospective cohort study enrolled 180 patients undergoing elective gynecological laparoscopy under standardized ERAS protocols who received 8 mg intravenous dexamethasone either 30 min before anesthesia induction or immediately after abdominal incision closure. The primary outcome was the 48-h incidence of PONV. Secondary outcomes included inflammatory biomarkers, namely C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), ERAS recovery indicators, and safety outcomes. Preoperative dexamethasone administration was associated with a significantly lower 48-h PONV incidence than postoperative administration (16.7% vs. 40.0%, P < 0.001), accompanied by reduced symptom severity and shorter episode duration. Patients receiving preoperative dexamethasone also demonstrated lower inflammatory biomarker levels at 24 and 48 h, faster achievement of postoperative recovery milestones, and a shorter hospital length of stay (2.1 vs. 3.2 days, P < 0.001), while safety outcomes were comparable between groups. These findings suggest that preoperative dexamethasone administration is associated with improved PONV control, attenuated perioperative inflammatory responses, and accelerated recovery in patients undergoing ERAS gynecological laparoscopy and may represent a useful strategy for optimizing perioperative care in this population.