Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 3;19(1):14.
doi: 10.1186/s13018-023-04485-y.

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

Ping Mou #  1   2   3 , Xiao-Dan Zhao #  4 , Xin-Yu Cai  5 , Zun-Han Liu  6 , Cheng-Qi He  7   8
Affiliations

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

Ping Mou et al. J Orthop Surg Res. .

Abstract

Background: Concerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA.

Methods: This retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified.

Results: Preoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl.

Conclusions: Although preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl.

Keywords: Dexamethasone; Diabetes mellitus; Glycemic control; Total joint arthroplasty.

PubMed Disclaimer

Conflict of interest statement

The author declares that they have no competing interests.

Figures

Fig.1
Fig.1
Flow diagram of the study design
Fig. 2
Fig. 2
A The level of FBG and FBG changes preoperatively and postoperatively. FBG = fasting blood glucose; POD = postoperative day. B The level of FBG change from baseline postoperatively. FBG = fasting blood glucose; POD = postoperative day. ■ meant there was statistical difference between group A and B. # meant there was statistical difference between group A and C. ★ meant there was statistical difference between group B and C
Fig.3
Fig.3
Receiver operating characteristic curve to determine the preoperative HbA1c level threshold, which increases the risk for postoperative blood glucose ≥ 11.1 mmol/L after TJA. AUC = area under the curve; TJA = total joint arthroplasty
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet. 2022;400(10365):1803–1820. doi: 10.1016/s0140-6736(22)01655-5. - DOI - PubMed
    1. Ogurtsova K, Guariguata L, Barengo NC, Ruiz PL, Sacre JW, Karuranga S, et al. IDF diabetes Atlas: Global estimates of undiagnosed diabetes in adults for 2021. Diabetes Res Clin Pract. 2022;183:109118. doi: 10.1016/j.diabres.2021.109118. - DOI - PubMed
    1. Rudy MD, Ahuja NK, Aaronson AJ. Diabetes and hyperglycemia in lower-extremity total joint arthroplasty: clinical epidemiology, outcomes, and management. JBJS Rev. 2018;6(5):e10. doi: 10.2106/jbjs.Rvw.17.00146. - DOI - PubMed
    1. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013;110(2):191–200. doi: 10.1093/bja/aes431. - DOI - PMC - PubMed
    1. Tien M, Gan TJ, Dhakal I, White WD, Olufolabi AJ, Fink R, et al. The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study. Anaesthesia. 2016;71(9):1037–1043. doi: 10.1111/anae.13544. - DOI - PubMed

MeSH terms