Dexamethasone-Associated Hyperglycemia is Not Associated With Infectious Complications After Total Joint Arthroplasty in Diabetic Patients

» Perioperative corticosteroids are strongly recommended for reducing the incidence and severity of postoperative nausea and vomiting following elective total hip or total knee arthroplasty.» Corticosteroids may reduce postoperative pain and opioid requirements. Similarly, corticosteroids appear to have a neutral-to-positive effect on length of stay, venous thromboembolism, mobility, delirium, acute kidney injury, and bone cement implantation syndrome (i.e., decreased length of stay).» Perioperative corticosteroids may induce hyperglycemia among both diabetic and nondiabetic patients; however, there is no strong evidence indicating that these transient corticosteroid-induced glycemic derangements may increase the risk of postoperative infectious complications.» The dosage and frequency of perioperative corticosteroid administration play a critical role in optimizing postoperative outcomes, with higher doses showing promise in reducing opioid consumption, postoperative pain, and length of stay.» The optimal dosage and frequency of corticosteroids remain unclear; however, the perioperative administration of 8 to 16 mg dexamethasone, or equivalent steroid, appears reasonable and safe in most cases.

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Effects of High-Dose Dexamethasone on Postoperative Opioid Consumption and Perioperative Glycemia in Fast-Track Primary Hip Arthroplasty: a Retrospective Cohort Study

Quillama,

Cuñat,

Saavaedra

et al. 2024

Preprint

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Background and Purpose - Standard recommendations for fast-track hip arthroplasty suggest using 8–10 mg of dexamethasone to reduce opioid consumption, with potential benefits of higher doses but scarce data on glycemic control and complications. This study compares the effects of higher doses versus the standard doses on postoperative opioid consumption, and secondarily, numerical pain scale, glycaemic control, hospital length of stay and postoperative complications.Methods - Retrospective cohort study of patients scheduled for FAST-TRACK primary hip arthroplasty between 2016–2021. Propensity score-matched analyses compared the standard dose group (4–8 mg) versus the high-dose group (16–24 mg).Results - 168 patients were included (56 with 4–8 mg, 112 with 16–24 mg). After one-to-one propensity score matching, 52 patients were included in the standard group and 52 in the high-dose group. After matching, the median [IQR] opioid consumption in the low-dose group was 10 [0–12] and in the high-dose group was 0 [0–10], with a 95% CI of -1 to 0 (p = 0.016). In the matched group, there was a median difference of 8 mg/dL (95% CI, -2 to 7, P < 0.05) in the immediate postoperative glycaemia, of 17 mg/dl (95% CI, -2 to 14, P < 0.05) in glycaemia at 24 hours and of -1 day (95% CI, -1 to 0, P < 0.05) in hospital stay. No differences in the numerical pain scale and postoperative complications were found.Conclusion - High-dose dexamethasone slightly increased perioperative glycemia while reducing opioid consumption and significantly shortening hospital length of stay.

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Dexamethasone-Associated Hyperglycemia is Not Associated With Infectious Complications After Total Joint Arthroplasty in Diabetic Patients

Cited by 3 publications

References 53 publications

Effect of systemic steroids administration in the clinical outcome of total hip arthroplasty: a systematic review and meta-analysis of prospective randomized controlled trials

Effect of systemic steroids administration in the clinical outcome of total hip arthroplasty: a systematic review and meta-analysis of prospective randomized controlled trials

Perioperative Systemic Corticosteroids in Modern Total Hip and Knee Arthroplasty

Effects of High-Dose Dexamethasone on Postoperative Opioid Consumption and Perioperative Glycemia in Fast-Track Primary Hip Arthroplasty: a Retrospective Cohort Study

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