Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty

Park, Hyung Jun; Chang, Moon Jong; Kim, Tae Woo; Kang, Kee Soo; Chang, Chong Bum; Kang, Sungchul

doi:10.1016/j.arth.2021.07.021

Cited by 12 publications

(15 citation statements)

References 46 publications

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“…The elevated blood glucose levels were associated with complications after TJA, particularly in diabetic patients [ 9 , 18 , 19 ]. Consequently, the orthopedic surgeons have exhibited reluctance in intravenously administering dexamethasone to patients during the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

“…However, TJA intervention and anesthesia may induce metabolic disorders, resulting in poorly controlled postoperative blood glucose, particularly in diabetic patients [ 8 , 9 ]. Additionally, operation-related soft tissue injury can trigger systemic inflammatory response and insulin resistance to exacerbate challenges in glycemic control [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The dual nature of dexamethasone, with both positive and negative effects, prompts an exploration of its comprehensive impact on glycemic control in type 2 DM patients undergoing TJA. Several studies have discussed the relationships of dexamethasone to blood glucose in diabetic patients undergoing TJA and they preliminarily concluded that an initial increase in blood glucose was observed after dexamethasone administration, yet there was no increase in the rate of infection [ 9 , 16 – 19 ]. However, the current studies were limited by different dexamethasone administration ways [ 16 ], different dexamethasone doses [ 18 ], small sample size [ 9 , 16 , 17 ], non-diabetic patients included [ 16 , 18 ], and oversight of food effects [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have discussed the relationships of dexamethasone to blood glucose in diabetic patients undergoing TJA and they preliminarily concluded that an initial increase in blood glucose was observed after dexamethasone administration, yet there was no increase in the rate of infection [ 9 , 16 – 19 ]. However, the current studies were limited by different dexamethasone administration ways [ 16 ], different dexamethasone doses [ 18 ], small sample size [ 9 , 16 , 17 ], non-diabetic patients included [ 16 , 18 ], and oversight of food effects [ 19 ]. Consequently, further study was needed to identify the effect of dexamethasone on blood glucose levels in diabetic patients undergoing TJA.…”

Section: Introductionmentioning

confidence: 99%

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The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

Mou,

Zhao,

Cai

et al. 2024

J Orthop Surg Res

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Background Concerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA. Methods This retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified. Results Preoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl. Conclusions Although preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

Mou,

Zhao,

Cai

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

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“…However, the majority of studies do not support this hypothesis [14]. The application of dexamethasone in diabetes mellitus has transient effects in elevating glucose, which may require changes in administration of diabetic medication [32]. Further study should compare whether extent of muscle damage or acute inflammation depends on details of perioperative management or patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study

Chen

Sun

Wang

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Controversies remain on the best surgical approaches for unilateral total hip arthroplasty (THA). There are little data on simultaneous bilateral THA via direct anterior approach (SimBDAA-THA) or posterolateral approach (SimBPA-THA). Purpose: We sought to assess differences in perioperative outcomes and early medical and surgical complications between SimBDAA-THA and SimBPA-THA. Methods: This retrospective study involved patients who underwent either SimBDAA-THA in a supine position (n = 73) or SimBPA-THA in a lateral position (n = 162) at our institution from January 2015 to November 2021. The 2 groups were compared in terms of clinical and demographic characteristics, surgical parameters, and complications during 6-months of follow-up. Results: There were no differences in clinical and demographic characteristics between the 2 groups prior to surgery. Simultaneous bilateral THA via direct anterior approach significantly shortened the length of both the operation (117.50 ±19.42 vs 143.97 ± 32.20 min) and the hospitalization (140.64 ± 43.22 vs 156.24 ± 56.64 h) but increased perioperative loss of hemoglobin (3.28 ± 1.01 vs 3.21 ± 2.26 g/dL). There were no significant differences between the two groups in transfusion rate; levels of interleukin-6, C-reactive protein or creatine kinase; or complications. Conclusion: This retrospective study of patients at a single institution found minimal differences in perioperative outcomes or early medical and surgical complications between SimBDAA-THA and SimBPA-THA except operative time and length of hospitalization. Larger studies with longer follow-up should be conducted to identify whether a direct anterior approach is superior to a posterolateral one.

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Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study

Arraut

Thomas

Oakley

et al. 2023

The Journal of Arthroplasty

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Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty

Cited by 12 publications

References 46 publications

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

Comparison of Perioperative Outcomes and Early Complications Between a Direct Anterior Approach or Posterolateral Approach in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Study

Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study

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