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Multicenter Study
. 2023 Jul 1;278(1):e105-e114.
doi: 10.1097/SLA.0000000000005526. Epub 2022 Jul 18.

Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery: A Multicentric Cohort Study

Michael Blank  1   2   3 , Anastasia Katsiampoura  1 , Luca J Wachtendorf  1   2   3 , Felix C Linhardt  1   2   3 , Tim M Tartler  1   2 , Dana Raub  1 , Omid Azimaraghi  2   3 , Guanqing Chen  2 , Tim T Houle  4 , Cristina Ferrone  5 , Matthias Eikermann  3   6 , Maximilian S Schaefer  1   2   7
Affiliations
Multicenter Study

Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery: A Multicentric Cohort Study

Michael Blank et al. Ann Surg. .

Abstract

Objective: We examined the effects of dexamethasone on postoperative mortality, recurrence-free survival, and side effects in patients undergoing oncologic operations.

Background: Dexamethasone prevents nausea and vomiting after anesthesia and may affect cancer proliferation.

Methods: A total of 30,561 adult patients undergoing solid cancer resection between 2005 and 2020 were included. Multivariable logistic regression was applied to investigate the effect of dexamethasone on 1-year mortality and recurrence-free survival. Effect modification by the cancer's potential for immunogenicity, defined as a recommendation for checkpoint inhibitor therapy based on the National Comprehensive Cancer Network guidelines, was investigated through interaction term analysis. Key safety endpoints were dexamethasone-associated risk of hyperglycemia >180 mg/dL within 24 hours and surgical site infections within 30 days after surgery.

Results: Dexamethasone was administered to 38.2% (11,666/30,561) of patients (6.5±2.3 mg). Overall, 3.2% (n=980/30,561) died and 15.4% (n=4718/30,561) experienced cancer recurrence within 1 year of the operation. Dexamethasone was associated with a -0.6% (95% confidence interval: -1.1, -0.2, P =0.007) 1-year mortality risk reduction [adjusted odds ratio (OR adj ): 0.79 (0.67, 0.94), P =0.009; hazard ratio=0.82 (0.69, 0.96), P =0.016] and higher odds of recurrence-free survival [OR adj : 1.28 (1.18, 1.39), P <0.001]. This effect was only present in patients with solid cancers who were defined as not to respond to checkpoint inhibitor therapy [OR adj : 0.70 (0.57, 0.87), P =0.001 vs OR adj : 1.13 (0.85, 1.50), P =0.40]. A high (>0.09 mg/kg) dose of dexamethasone increased the risk of postoperative hyperglycemia [OR adj : 1.55 (1.32, 1.82), P <0.001], but not for surgical site infections [OR adj : 0.84 (0.42, 1.71), P =0.63].

Conclusions: Dexamethasone is associated with decreased 1-year mortality and cancer recurrence in patients undergoing surgical resection of cancers that are not candidates for immune modulators. Dexamethasone increased the risk of postoperative hyperglycemia, however, no increase in surgical site infections was identified.

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Conflict of interest statement

M.E. has received grants for investigator-initiated trials not related to this manuscript from Merck & Co. and serves as a consultant on the advisory board of Merck & Co. He is an Associate Editor of the British Journal of Anaesthesia . M.S. has received grants for investigator-initiated studies not related to this manuscript from Merck & Co. and is an Associate Editor of BMC Anesthesiology . T.T.H. reports grants from the National Institute of Neurological Disorders and Stroke (PI), grants from the National Institute of General Medical Sciences, personal fees from Headache, personal fees from Anesthesiology, and personal fees from Cephalalgia outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work. The remaining authors report no conflicts of interest.

References

    1. Weibel S, Schaefer MS, Raj D, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: an abridged Cochrane network meta-analysis. Anaesthesia. 2021;76:962–973.
    1. Tarantino I, Warschkow R, Beutner U, et al. Efficacy of a single preoperative dexamethasone dose to prevent nausea and vomiting after thyroidectomy (the tPONV Study): a randomized, double-blind, placebo-controlled clinical trial. Ann Surg. 2015;262:934–940.
    1. Karanicolas PJ, Smith SE, Kanbur B, et al. The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy: a systematic review and meta-analysis. Ann Surg. 2008;248:751–762.
    1. Srinivasa S, Kahokehr AA, Yu TC, et al. Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials. Ann Surg. 2011;254:183–191.
    1. Bressan AK, Isherwood S, Bathe OF, et al. Preoperative single-dose methylprednisolone prevents surgical site infections after major liver resection: a randomized controlled trial. Ann Surg. 2022;275:281–287.

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