Presentation Details
| Effects of Perioperative Dexamethasone in Patients with Diabetes Ethan C Goldner1, Elizabeth Miles2, Kaeli Samson3, Jason F Shiffermiller4. 1College of Medicine, UNMC, Omaha, NE, USA.2MD, PhD, Division of Hospital Medicine, UNMC, Omaha, NE, USA.3MPH, Department of Biostatistics, UNMC, Omaha, NE, USA.4MD, MPH, Division of Hospital Medicine, UNMC, Omaha, NE, USA |
Abstract
BACKGROUND: Perioperative dexamethasone is frequently administered as prophylaxis against post-operative nausea and vomiting. Dexamethasone administration in patients with diabetes, however, may lead to hyperglycemia and hyperglycemia-related complications. The aim of this project is to evaluate the association between perioperative dexamethasone administration and hospital length of stay in patients with diabetes.
METHODS: We performed a single-center, retrospective cohort study of patients with type I or type II diabetes who were admitted for an operating room procedure. Patients were divided into two groups based on whether they were administered dexamethasone on the day of surgery. Analyses were conducted using t-tests, Wilcoxon rank sum tests, or Chi-squared tests as appropriate.
RESULTS: We included 7,352 patients with diabetes who underwent an operating room procedure. Dexamethasone was administered on the day of surgery to 3,225 patients at a median dose of 4.0 mg (IQR 4.0-8.0). The remaining 4,127 received no dexamethasone on the day of surgery. We found that median hospital LOS in the dexamethasone group was 3.0 days (IQR 1.0-7.0) compared to 6.0 days (IQR 3.0-11.0) in the no dexamethasone group (p<0.001). Additionally, patients in our dexamethasone group were less likely to be admitted to the ICU (27.1% vs. 37.6%, p<0.001), less likely to suffer inpatient mortality (0.9% vs. 2.4%, p<0.001), and less likely to be readmitted within 90 days (15.2% vs. 23.1%, p<0.001).
CONCLUSIONS: In patients with diabetes undergoing an operating room procedure, we found that perioperative dexamethasone administration was associated with shorter hospital LOS and lower risk of complications. This contradicts the hypothesis that dexamethasone-associated hyperglycemia would lead to an increase in risk of perioperative complications. Our analysis is limited by the likely presence of confounding by diabetes severity, among other factors. We are planning a regression analysis. These initial findings suggest the need for a prospective trial.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: We performed a single-center, retrospective cohort study of patients with type I or type II diabetes who were admitted for an operating room procedure. Patients were divided into two groups based on whether they were administered dexamethasone on the day of surgery. Analyses were conducted using t-tests, Wilcoxon rank sum tests, or Chi-squared tests as appropriate.
RESULTS: We included 7,352 patients with diabetes who underwent an operating room procedure. Dexamethasone was administered on the day of surgery to 3,225 patients at a median dose of 4.0 mg (IQR 4.0-8.0). The remaining 4,127 received no dexamethasone on the day of surgery. We found that median hospital LOS in the dexamethasone group was 3.0 days (IQR 1.0-7.0) compared to 6.0 days (IQR 3.0-11.0) in the no dexamethasone group (p<0.001). Additionally, patients in our dexamethasone group were less likely to be admitted to the ICU (27.1% vs. 37.6%, p<0.001), less likely to suffer inpatient mortality (0.9% vs. 2.4%, p<0.001), and less likely to be readmitted within 90 days (15.2% vs. 23.1%, p<0.001).
CONCLUSIONS: In patients with diabetes undergoing an operating room procedure, we found that perioperative dexamethasone administration was associated with shorter hospital LOS and lower risk of complications. This contradicts the hypothesis that dexamethasone-associated hyperglycemia would lead to an increase in risk of perioperative complications. Our analysis is limited by the likely presence of confounding by diabetes severity, among other factors. We are planning a regression analysis. These initial findings suggest the need for a prospective trial.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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