Dexamethasone and Surgical-Site Infection

Corcoran, Tomás; Myles, Paul S.; Forbes, Andrew; Cheng, Allen; Bach, Leon A.; O’Loughlin, Edmond; Leslie, Kate; Chan, Matthew T. V.; Story, David A; Short, Timothy G.; Martin, Catherine; Coutts, Pauline; Ho, Kwok M.

doi:10.1056/nejmoa2028982

Cited by 99 publications

(90 citation statements)

References 27 publications

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“… 32 A recently published trial of 8725 patients receiving 8 mg dexamethasone or placebo concurs with the aforementioned findings as it showed no difference in surgical site infection and no difference in safety outcomes between the groups. 33 …”

Section: Discussionmentioning

confidence: 99%

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Gasbjerg

Hägi‐Pedersen

Lunn

et al. 2022

BMJ

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Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty. Design Randomised, blinded, placebo controlled trial with follow-up at 90 days. Setting Five Danish hospitals, September 2018 to March 2020. Participants 485 adult participants undergoing total knee arthroplasty. Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia. Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain. Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone. Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. Trial registration Clinicaltrials.gov NCT03506789 .

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Section: Discussionmentioning

confidence: 99%

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Gasbjerg

Hägi‐Pedersen

Lunn

et al. 2022

BMJ

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“…Multiple systematic reviews have demonstrated reduced postoperative pain scores, shorter PACU stays, and lower opioid requirements in patients who received intraoperative dexamethasone (75,76). There is no evidence to suggest an increased risk of infections or delayed wound healing, however hyperglycemia is a known side-effect of glucocorticoids (77). There is conflicting data on the optimal dose, with an initial systematic review showing analgesic effects at doses greater than 0.1 mg/kg (75), while more recent review did not confirm a dose-response relationship (76).…”

Section: Corticosteroidsmentioning

confidence: 99%

Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

Hamilton¹,

Alfille²,

Mountjoy³

et al. 2022

J Thorac Dis

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Background and Objective: Thoracic surgery causes significant pain which can negatively affect pulmonary function and increase risk of postoperative complications. Effective analgesia is important to reduce splinting and atelectasis. Systemic opioids and thoracic epidural analgesia (TEA) have been used for decades and are effective at treating acute post-thoracotomy pain, although both have risks and adverse effects. The advancement of thoracoscopic surgery, a focus on multimodal and opioid-sparing analgesics, and the development of ultrasound-guided regional anesthesia techniques have greatly expanded the options for acute pain management after thoracic surgery. Despite the expansion of surgical techniques and analgesic approaches, there is no clear optimal approach to pain management. This review aims to summarize the body of literature regarding systemic and regional anesthetic techniques for thoracic surgery in both thoracotomy and minimally invasive approaches, with a goal of providing a foundation for providers to make individualized decisions for patients depending on surgical approach and patient factors, and to discuss avenues for future research.Methods: We searched PubMed and Google Scholar databases from inception to May 2021 using the terms "thoracic surgery", "thoracic surgery AND pain management", "thoracic surgery AND analgesia", "thoracic surgery AND regional anesthesia", "thoracic surgery AND epidural". We considered articles written in English and available to the reader.

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“…The nationally determined methodology to record hospital acquired complications will underestimate morbidity relative to prospective audit 17 . This is especially true where clinical note keeping is lacking or where complications that occur frequently after hospital discharge are assessed, such as surgical site infection 18 . Furthermore, our measure of DAH-30 doesn’t account for admissions in the private, non-metropolitan sectors, and likely over-estimates performance.…”

Section: Discussionmentioning

confidence: 99%

The external validity of four risk scores predicting 30-day mortality after surgery

Torlot

Yew

Reilly

et al. 2022

Preprint

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Background Surgical risk prediction tools can facilitate shared-decision-making and efficient allocation of perioperative resources. Such tools should be externally validated in target populations prior to implementation. Methods Predicted risk of 30-day mortality was retrospectively derived for surgical patients at Royal Perth Hospital from 2014 to 2021 using the Surgical Outcome Risk Tool (SORT) and the related NZRISK (n=44,031, 53,395 operations). In a sub-population (n=31,153), the Physiology and Operative Severity Score for the enumeration of Mortality (POSSUM) and the Portsmouth variant of this (P-POSSUM) were matched from the Copeland Risk Adjusted Barometer (C2-Ai, Cambridge, UK). The primary outcome was risk score discrimination of 30-day mortality as evaluated by area-under-receiver operator characteristic curve (AUROC) statistics. Calibration plots and outcomes according to risk decile and time were also explored. Results All four risk scores showed high discrimination (AUROC) for 30-day mortality (SORT=0.922, NZRISK=0.909, P-POSSUM=0.893; POSSUM=0.881) but consistently over-predicted risk. SORT exhibited the best discrimination and calibration. Thresholds to denote the highest and second-highest deciles of SORT risk (>3.92% and 1.52-3.92%) captured the majority of deaths (76% and 13% respectively) and hospital-acquired-complications. Year-on-year SORT calibration performance drifted towards over-prediction, reflecting a decrease in 30-day mortality over time despite an increase in the surgical population risk. Conclusions SORT was the best performing risk score in predicting 30-day mortality after surgery. Categorising patients based on SORT into low, medium (80-90th percentile) and high-risk (90-100th percentile) can guide future allocation of perioperative resources. No tools were sufficiently calibrated to support shared-decision-making based on absolute predictions of risk.

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Dexamethasone and Surgical-Site Infection

Cited by 99 publications

References 27 publications

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Regional anesthesia and acute perioperative pain management in thoracic surgery: a narrative review

The external validity of four risk scores predicting 30-day mortality after surgery

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