Perioperative dexamethasone: Effects on length of stay, perioperative outcomes, and safety in isolated lower extremity long bone fracture fixation

Abstract

Background: Corticosteroids are frequently administered perioperatively during arthroplasty procedures with reported reductions in length of stay (LOS), postoperative pain & nausea, and opioid consumption. This investigation aims to evaluate the effects of perioperative dexamethasone on LOS, post-operative outcomes, and adverse event rates for trauma patients undergoing femoral/tibial intramedullary nailing (IMN).

Methods: A retrospective cohort study was conducted at an urban Level 1 Trauma center between May 2018 and May 2022. 201 patients aged 16-65 with isolated femur or tibia fractures treated with antegrade or retrograde femoral or tibial IMN underwent chart review. Those with mental or physical disability, GFR <30, liver disease, poorly controlled diabetes (HbA1C ≥ 8), or steroid use within 3 months were excluded. Patients with both open and closed fractures were included in the study. LOS postoperatively was compared between patients who received dexamethasone perioperatively (Dex, n = 88) and those who did not (No Dex, n = 113). Secondary outcomes pertained to inpatient admission (e.g. average pain score), time to union, incidence of nonunion by 6 months, and 90-day surgical site infection rate. Categorical outcomes were analyzed using Wilcoxon rank-sum analysis and dichotomous data using chi-square testing.

Results: There was no difference in LOS between groups (Dex 2.0 ± 1.6 days, No Dex 2.1 ± 1.3 days). While the Dex group had lower rates of superficial infection (Dex 0 % [0/43], No Dex 13.5 % [5/37]), opioid consumption (morphine milligram equivalent [MME]) on postoperative day 0 (Dex 16.7 ± 16.1, No Dex 21.1 ± 17.4), and MME POD0-3 average (Dex 24.5 ± 16.5, No Dex 30.5 ± 18.3), these results were not statistically significant. There were no differences in other secondary outcomes, including time to union, pain scores, average blood glucose, and complication rates.

Conclusion: Despite previous literature supporting a reduction in LOS associated with perioperative dexamethasone administration, the current study demonstrated no difference in trauma patients undergoing tibial or femoral IMN. However, perioperative administration may provide short-term benefits without increasing adverse event rate.

Keywords: Dexamethasone; Femoral fractures; Fracture fixation; Intramedullary; Pain; Postoperative; Postoperative period; Tibial fractures.