Efficacy of Preoperative Usage of Dexamethasone in Diabetic Patients Undergoing Total Hip or Knee Arthroplasty for Control of Nausea and Vomiting

Abstract

Background Dexamethasone has been used in surgical patients to decrease nausea, vomiting, and postoperative pain. However, it is not well studied how much dexamethasone complicates glucose control in diabetic patients and whether this leads to poor surgical outcomes. Methods We analyzed 256 diabetic patients who underwent elective hip and knee arthroplasty and evaluated the groups that received dexamethasone intraoperatively (201 patients), those who received dexamethasone postoperatively (237 patients), and those who did not receive the steroid intraoperatively (55 patients) and postoperatively (19 patients). Results 256 diabetic patients were included in the study. The mean age of the group was 68.7 (SD ± 9-10) years. Patients were divided into 123 males (48%) and 133 females (52%). 174 (78%) patients had a total knee replacement operation, and 82 (32%) patients had total hip replacement operation. The mean hemoglobin A1c was 6.728 (SD ± 0.99). The mean ASA score was 2.86 (SD ± 0.38). 201 (78.5%) patients received preoperative or intraoperative dexamethasone, and 237 (92.6%) patients received it postoperatively. The mean blood glucose for all patients raised from 131.9 to 172.2 mg/dL ( P = .012) postoperatively, 206.1 mg/dL in the first 24 hours, and 146.2 mg/dL ( P = .39) in the second postoperative day. The change was significant in patients who had poorly controlled diabetes ( P < .01) preoperatively. There was no significant difference in our study regarding dexamethasone use and effect on postoperative nausea ( P = 1.0) and vomiting ( P = .52). There was an improvement in pain scores in the patients who received dexamethasone postoperatively which was statistically significant ( P = .054). Conclusion Dexamethasone use in diabetic patients for control of postoperative nausea and vomiting in those undergoing elective total knee and hip arthroplasty had a negative impact on glycemic control specifically in those with poorly controlled diabetes and should be avoided.

The Effects of Dexamethasone in Diabetic Patients Undergoing Primary Total Joint Arthroplasty

“…In concurrence with O'Connell et al ( 2018) and Wasfie et al (2021), these findings add support to the conflicting body of literature that dexamethasone does cause increased blood glucose levels in diabetic patients undergoing TJA. These findings also support the existing consensus in the literature that dexamethasone administration is not associated with increased incidence of PJIs in the general TJA population or in the diabetic patient population (Allen et al, 2020;Godshaw et al, 2019;Klement et al, 2018;O'Connell et al, 2018;Richardson et al, 2016;Wasfie et al, 2021).…”

“…There have been differing reports regarding whether perioperative dexamethasone use in diabetic patients undergoing TJA causes significant postoperative hyperglycemia. Two studies found that patients have increased hyperglycemia postoperatively but with no link to clinical significance (O'Connell et al, 2018; Wasfie et al, 2021). In contrast, two studies found that dexamethasone did not increase postoperative hyperglycemia (Allen et al, 2020; Godshaw et al, 2019).…”

Effect of dexamethasone administration for postoperative nausea and vomiting prophylaxis on glucose levels in adults with diabetes undergoing elective surgery: a systematic review and meta-analysis

“…Reasons for exclusion after full-text examination are shown in Appendix II. These reasons include no control group with diabetes, 36–39 exclusion of participants with diabetes, 40–42 inclusion of participants with impaired glucose tolerance but no formal diagnosis of diabetes mellitus, 43 administration of multiple dexamethasone doses, 23 use of oral dexamethasone, 44 report of average rather than maximal blood glucose level, 45 failure to report quantitative blood glucose, 46 and grouping of participants with and without diabetes in a single data set 47 …”

“…These reasons include no control group with diabetes, [36][37][38][39] exclusion of participants with diabetes, [40][41][42] inclusion of participants with impaired glucose tolerance but no formal diagnosis of diabetes mellitus, 43 administration of multiple dexamethasone doses, 23 use of oral dexamethasone, 44 report of average rather than maximal blood glucose level, 45 failure to report quantitative blood glucose, 46 and grouping of participants with and without diabetes in a single data set. 47 Eleven studies were critically appraised and underwent data extraction and synthesis (Figure 1). Ten studies were ultimately included in the meta-analysis.…”

Letter re: Efficacy of Preoperative Usage of Dexamethasone in Diabetic Patients Undergoing Total Hip or Knee Arthroplasty for Control of Nausea and Vomiting

“…We were particularly interested in the article by Wasfie TJ et al 1 that evaluated the preoperative use of dexamethasone in diabetic patients undergoing total hip or knee arthroplasty for control of nausea and vomiting. They conclude that, when compared to other antiemetics, dexamethasone had no discernible effect on postoperative nausea and vomiting in diabetic patients having elective total knee and hip arthroplasty.…”