Dexamethasone and postoperative hyperglycemia in diabetics undergoing elective hip or knee arthroplasty: a case control study in 238 patients.

Autor: O'Connell RS; 1Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, Virginia 23298 USA., Clinger BN; 2School of Medicine, Virginia Commonwealth University, 1201 E Marshall St,, Richmond, Virginia 23298 USA., Donahue EE; 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, P.O. Box 980032, Richmond, Virginia 23298 USA., Celi FS; 4Division of Endocrinology Diabetes and Metabolism, Department of Internal Medicine, Virginia Commonwealth University, 1101 East Marshall Street, Sanger Hall, PO Box 980111, Richmond, Virginia 23298 USA., Golladay GJ; 5Department of Orthopaedic Surgery, Virginia Commonwealth University, P.O. Box 980153, Richmond, Virginia 23298 USA.
Jazyk: angličtina
Zdroj: Patient safety in surgery [Patient Saf Surg] 2018 Nov 05; Vol. 12, pp. 30. Date of Electronic Publication: 2018 Nov 05 (Print Publication: 2018).
DOI: 10.1186/s13037-018-0178-9
Abstrakt: Background: Dexamethasone has been routinely used in the pre-operative setting to enhance analgesia and decrease the incidence of nausea and vomiting in patients undergoing primary arthroplasty. However, dexamethasone has the potential to increase blood glucose levels postoperatively, which is a known risk factor for complications after total joint arthroplasty. The aim of this study was to analyze the effect of dexamethasone administration on post-operative blood glucose levels in diabetic patients after primary hip and knee arthroplasty.
Methods: This study was a retrospective review of 238 diabetic patients who underwent primary hip and knee arthroplasty between May 1, 2014 and September 30, 2016 at a single urban academic medical center. A total of 77 patients (32.4%) received dexamethasone and 161 (67.7%) did not. Oral hyperglycemic agents were held during the inpatient stay and blood glucose was controlled either with sliding scale insulin or home insulin regimens were continued. All analyses were adjusted for age, BMI, gender, type of diabetes, pre-operative diabetic medication, type of surgical procedure, and pre-operative HgbA1c level. The primary outcome was post-operative hyperglycemia within 72 h of surgery defined as any blood glucose level greater than or equal to 200 mg/dL.
Results: Post-operative hyperglycemia was observed in 17.1 and 20.6% of the measurements during the first 24 and 72 h respectively. After controlling for confounding variables, patients who received dexamethasone had 4.07 (95% CI: 2.46, 6.72) and 3.08 (95% CI: 2.34, 4.04) higher odds of post-operative hyperglycemia in the first 24 and 72 h respectively.
Conclusions: Dexamethasone administration in diabetic patients undergoing primary arthroplasty increases post-operative hyperglycemia during the first 24 and 72 h. While our data did not investigate causation, dexamethasone use in this patient population should be thoughtfully considered, as post-operative hyperglycemia is a known risk factor for complications.
Competing Interests: This study was approved by the VCU Health System IRB.There is no information with individual personal data so no consent for publication was needed.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Databáze: MEDLINE
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