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

Abstract

Dexamethasone reduces postoperative pain and nausea, with no evidence of increased rate of infection in total joint arthroplasty. However, the effects of dexamethasone on diabetic patients undergoing total joint arthroplasty remain relatively unexplored. The purpose of this study was to examine the effects of dexamethasone on postoperative blood glucose levels, prosthetic joint infections (PJIs), and 90-day hospital returns in diabetic patients following total joint arthroplasty. Retrospective analysis was performed on 228 adult patients with a diagnosis of diabetes who underwent primary total joint arthroplasty. Patients were stratified by intraoperative dexamethasone administration. In total, 173 (75.9%) patients received intraoperative dexamethasone, with no differences in demographic variables compared with patients who did not receive dexamethasone. There was no significant difference in PJIs or 90-day hospital returns. Patients who received dexamethasone had significantly increased blood glucose concentration on Postoperative Day 1 and were significantly more likely to have blood glucose levels exceeding 180 g/dl. Although postoperative blood glucose levels were significantly increased, it is unclear what effects, if any, transient hyperglycemia may have on outcomes. The outcomes of this study support perioperative administration of dexamethasone in diabetic patients.

The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis

“…The full versions of 41 articles were retrieved after screening and conducting a detailed selection process. Finally 16 articles (Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Backes et al 2013;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Herbst et al 2020;Godshaw et al 2019;Allen et al 2020;Egan et al 2019;Harding et al 2021;O'Connell et al 2018;Corcoran et al 2021b) met the inclusion criteria and underwent data extraction. The details of the screening procedure are shown in Fig.…”

“…Ten (Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Egan et al 2019;Corcoran et al 2021b), six (Tien et al 2016;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018), nine (Nazar et al 2011;Tien et al 2016;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014;Shang et al 2022;Wasfie et al 2018;Allen et al 2020;O'Connell et al 2018), six (Tien et al 2016;Corcoran et al 2021a;Shang et al 2022;Egan et al 2019;Harding et al 2021;O'Connell et al 2018) and two (Egan et al 2019;O'Connell et al 2018) studies reported glucose levels at baseline (preoperatively), intraoperatively (in the midterm of surgery), at the end of surgery, on postoperative day 1 (POD 1), and POD 2. The results in the trial by Corcoran TB 2020(Corcoran et al 2021a were split in the forest plot, with Corcoran TB 2020(1) representing the comparison between dexamethasone 4 mg with control, and Corcoran TB 2020(2) representing the comparison between dexamethasone 8 mg with control.…”

“…One RCT (Tien et al 2016) investigated insulin requirement, there was no difference in the percentage of patients requiring insulin within 24 hours of surgery, but insulin dosage over 24 hours of surgery was higher in dexamethasone group than in control (P = 0.03). Three cohort studies (Wasfie et al 2018;Allen et al 2020;Harding et al 2021) investigated insulin requirement, of which, 2 studies (Allen et al 2020;Harding et al 2021) reported postoperative insulin requirement, the other one (Wasfie et al 2018) reported intraoperative requirement, and showed no difference between groups. The results of insulin requirement on the day of surgery (POD 0) were from 2 cohort studies (Allen et al 2020;Harding et al 2021), the result showed that there were no significant between-group differences on POD 0 (SMD: 1.735, 95%CI: − 0.556-4.027, I 2 = 97.8%, P = 0.138); and those on POD1 were from only 1 study (Allen et al 2020), which showed no between-group differences (p < 0.05).…”

“…Two RCTs (Corcoran et al 2021a;Corcoran et al 2021b) and 2 cohort studies (Egan et al 2019;Harding et al 2021) representing the comparison between dexamethasone 4 mg with control, and Corcoran TB2020(2) representing the comparison between dexamethasone 8 mg with control. The result from meta-analysis with fixed model method revealed that there was no between-group difference in wound infection (OR: 0.797, 95%CI: 0.578-1.099, I 2 = 0%, P = 0.166) (Fig.…”

“…Godshaw et al 2019;Allen et al 2020;Egan et al 2019;Harding et al 2021;O'Connell et al 2018;Corcoran et al 2021b) were published from 2009 to 2022, 9 were RCTs(Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Backes et al 2013;Purushothaman et al 2018;Zhang et al 2014; Shang et al 2022;Corcoran et al 2021b), and the other 7(Wasfie et al 2018;Herbst et al 2020;Godshaw et al 2019;Allen et al 2020;Egan et al 2019;Harding et al 2021;O'Connell et al 2018) were cohort studies, all studies reported dexamethasone for antiemesis, and the dosage of dexamethasone ranged from 4 to 12 mg daily during the perioperative period. In the 9 RCTs, dexamethasone was administered at induction of anesthesia or before anesthesia, 8 studies(Nazar et al 2011;Tien et al 2016;Nazar et al 2009;Corcoran et al 2021a;Purushothaman et al 2018;Zhang et al 2014; Shang et al 2022;Corcoran et al 2021b) compared dexamethasone with saline, and 1(Backes et al 2013) compared dexamethasone with no treatment.…”