Impact of Perioperative Dexamethasone on Hospital Length of Stay and Glycemic Control in Patients With Type 2 Diabetes Undergoing Total Hip Arthroplasty

Authors

Vanessa Williams, Southern Illinois University School of MedicineFollow
Mohammad J. Uddin Ansari, Wellspan Medical GroupFollow
Amruta Jaju, Southern Illinois University School of MedicineFollow
Stacey Ward, Southern Illinois University School of MedicineFollow
Daniel O'Keefe, Southern Illinois University School of MedicineFollow
Jumana Abdelkarim, Southern Illinois University School of MedicineFollow
Nicole Montes, Memorial Physician ServicesFollow
Ula Tarabichi, Southern Illinois University School of MedicineFollow
Albert Botchway, Southern Illinois University School of MedicineFollow
Michael G. Jakoby IV, Southern Illinois University School of MedicineFollow

Publication Date

1-17-2023

Keywords

type 2 diabetes mellitus, hip arthroplasty, orthopedic surgery, glycemic control, dexamethasone, perioperative management

Abstract

Purpose: This study aimed to evaluate effects of perioperative dexamethasone on hospital length of stay (LOS) and glycemic control for patients with type 2 diabetes mellitus undergoing total hip arthroplasty (THA).

Methods: We performed retrospective case review of THA performed in adults (≥ 18 years old) with type 2 diabetes at Springfield Memorial Hospital (Springfield, IL) immediately before (2013), during (2014), and after (2015) publication of consensus guidelines for use of perioperative dexamethasone. Hospital LOS was the primary endpoint. Capillary blood glucose by hospital day, proportion of patients treated with insulin, and median insulin dose by hospital day were secondary endpoints.

Results: A total of 209 patients were included: 109 not dosed with dexamethasone (“no dexamethasone”), and 100 treated with perioperative dexamethasone. The most common dose of dexamethasone was 4 mg (63% of patients). Mean (95% CI) reduction in adjusted hospital LOS for dexamethasone-treated patients, compared to controls, was -2.8 (-3.7 to -1.9) days for all patients, -1.6 (-2.7 to -0.5) days for those with arthritis as the indication for THA, and -4.0 (-5.9 to -2.1) days for those with fracture as indication for THA (P < 0.001 for all). Glycemic control measured by median capillary blood glucose was no different or slightly better in the dexamethasone group than the no dexamethasone group, except for postoperative day 1 among patients treated with insulin prior to surgery.

Conclusions: Perioperative dexamethasone significantly reduces hospital LOS for patients with type 2 diabetes undergoing THA, with modest effects on hyperglycemia.

Recommended Citation

Williams V, Uddin Ansari MJ, Jaju A, Ward S, O’Keefe D, Abdelkarim J, Montes N, Tarabichi U, Botchway A, Jakoby MG 4th. Impact of perioperative dexamethasone on hospital length of stay and glycemic control in patients with type 2 diabetes undergoing total hip arthroplasty. J Patient Cent Res Rev. 2023;10:4-12. doi: 10.17294/2330-0698.1971