The effects of dexamethasone, light anesthesia, and tight glucose control on postoperative fatigue and quality of life after major noncardiac surgery: A randomized trial

Abstract

Study objectives: The postoperative period is associated with an inflammatory response that may contribute to a number of complications including postoperative fatigue (POF) that impair patients' quality of life (QoL). We studied the impact of three potentially anti-inflammatory interventions (steroid administration, tight intraoperative glucose control, and light anesthesia) on POF and QoL in patients having major noncardiac surgery.

Design: A randomized Trial.

Setting: Operating room and postoperative recovery area/ICU/hospital floors.

Patients: Patients undergoing major noncardiac surgery.

Interventions: Patients were randomized to perioperative IV dexamethasone (a total of 14 mg tapered over 3 days) versus placebo, intensive versus conventional glucose control (target 80-110 vs. 180-200 mg·dL^-1), and light versus deep anesthesia (Bispectral Index target of 55 vs. 35) in a 3-way factorial design.

Measurements: In this planned sub-analysis, QoL was measured using SF-12 preoperatively and on postoperative day (POD) 30. POF was measured using Christensen VAS, pre-operatively, POD 1, and POD 3. We assessed the effect of each intervention on POF and on the physical and mental components of SF-12 summary scores with repeated-measures linear regression models.

Main results: 326 patients with complete data were included in the SF-12 analysis and 306 were included in the QoL analysis. No difference was found between any of the intervention groups on fatigue or mean 30-day physical and mental components of SF-12 scores, after adjusting for preoperative score and imbalanced baseline variables (all P-value >0.07 for POF and >0.40 for QoL).

Conclusions: Steroid administration, tight intraoperative glucose control, and light anesthesia do not improve quality of life or postoperative fatigue after major surgery.

Keywords: Anesthesia; CRP; DeLiT trial; Dexamethasone; Noncardiac surgery; Outcomes; Perioperative inflammation; Postoperative fatigue.