Michael Nurok1, Jennifer Cheng2, Giulio R Romeo3, Stephanie M Vecino4, Kara G Fields5, Jacques T YaDeau2. 1. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, United States. Electronic address: Michael.Nurok@cshs.org. 2. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, United States. 3. Department of Molecular and Cellular Pharmacology, Joslin Diabetes Centre, Boston, MA, United States. 4. Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States. 5. Healthcare Research Institute, Hospital for Special Surgery, New York, NY, United States.
Abstract
STUDY OBJECTIVE: Perioperative dexamethasone is commonly used to prevent nausea. It can also increase blood glucose levels, and recent concern about its blood glucose-elevating effect in humans has been raised. This study aimed to demonstrate relationships between dexamethasone administration and elevated perioperative blood glucose in patients undergoing total joint arthroplasty. DESIGN: Retrospective study. SETTING: Academic, orthopedic hospital. PATIENTS: A total of 625 patients (18-99years) who underwent total hip or total knee arthroplasty with an ASA ≤3 were included in the study. INTERVENTIONS: Patients who received dexamethasone perioperatively were compared to those who did not receive dexamethasone. MEASUREMENTS: The primary outcome, which was any postoperative glucose >200mg/dl, was compared between groups using multiple logistic regression. Demographic information, intraoperative information, incidence of postoperative nausea and vomiting, white blood cell count, medication use, and length of stay were also collected. MAIN RESULTS: Perioperative dexamethasone (median [1st quartile, 3rd quartile] dose=4 [4, 8] mg) was administered to 76% of patients. Only 5.6% (95% CI: 3.8-7.5) of patients had postoperative glucose levels >200mg/dl. After covariate adjustment, there was no evidence of a difference in odds of experiencing postoperative glucose levels >200mg/dl (odds ratio [95% CI]: 0.76 [0.28-2.07]; P=0.594) and maximum glucose levels (P=0.518) between groups. Dexamethasone-treated patients had greater changes in white blood cell count between baseline and postoperative days 0-1. There was no evidence of a difference in wound healing and length of stay between groups. CONCLUSIONS: There was no evidence of an association between perioperative dexamethasone administration and the odds of having postoperative glucose levels >200mg/dl or higher maximum glucose levels. However, these findings may not be generalizable to patients having different baseline characteristics or procedures.
STUDY OBJECTIVE: Perioperative dexamethasone is commonly used to prevent nausea. It can also increase blood glucose levels, and recent concern about its blood glucose-elevating effect in humans has been raised. This study aimed to demonstrate relationships between dexamethasone administration and elevated perioperative blood glucose in patients undergoing total joint arthroplasty. DESIGN: Retrospective study. SETTING: Academic, orthopedic hospital. PATIENTS: A total of 625 patients (18-99years) who underwent total hip or total knee arthroplasty with an ASA ≤3 were included in the study. INTERVENTIONS:Patients who received dexamethasone perioperatively were compared to those who did not receive dexamethasone. MEASUREMENTS: The primary outcome, which was any postoperative glucose >200mg/dl, was compared between groups using multiple logistic regression. Demographic information, intraoperative information, incidence of postoperative nausea and vomiting, white blood cell count, medication use, and length of stay were also collected. MAIN RESULTS: Perioperative dexamethasone (median [1st quartile, 3rd quartile] dose=4 [4, 8] mg) was administered to 76% of patients. Only 5.6% (95% CI: 3.8-7.5) of patients had postoperative glucose levels >200mg/dl. After covariate adjustment, there was no evidence of a difference in odds of experiencing postoperative glucose levels >200mg/dl (odds ratio [95% CI]: 0.76 [0.28-2.07]; P=0.594) and maximum glucose levels (P=0.518) between groups. Dexamethasone-treated patients had greater changes in white blood cell count between baseline and postoperative days 0-1. There was no evidence of a difference in wound healing and length of stay between groups. CONCLUSIONS: There was no evidence of an association between perioperative dexamethasone administration and the odds of having postoperative glucose levels >200mg/dl or higher maximum glucose levels. However, these findings may not be generalizable to patients having different baseline characteristics or procedures.