Effects of Dexamethasone on Postoperative Glycemic Control in Patients After Primary Total Joint Arthroplasty: A Randomized Double-Blind Controlled Trial.

BACKGROUND: In patients undergoing total joint arthroplasty (TJA), the use of dexamethasone (DEX) may cause perioperative blood glucose (BG) disorders, leading to complications even in patients who do not have diabetes. We aimed to evaluate the effects of different DEX doses on perioperative BG levels.

METHODS: A total of 135 patients who do not have diabetes were randomized into three groups: preoperative intravenous injection of normal saline (Group A, the placebo group), preoperative intravenous injection of 10 mg DEX (Group B), and preoperative intravenous injection of 20 mg DEX (Group C). Postoperative fasting blood glucose (FBG) levels were designated as the primary outcome, while postoperative postprandial blood glucose (PBG) levels were assigned as the secondary outcome. The incidence of complications was recorded. We also investigated the risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl.

RESULTS: The FBG levels were higher in Groups B and C than in Group A on postoperative days (POD) 0 and 1. The PBG levels were lower for Groups A and B compared to Group C on POD 1. No differences in FBG or PBG were detected beyond POD 1. Elevated preoperative glycosylated hemoglobin A1c (HbA1c) levels increased the risk of FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl, respectively. However, preoperative intravenous injection of DEX was not associated with FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. No differences were found in postoperative complications among the three groups.

CONCLUSION: The preoperative intravenous administration of 10 or 20 mg DEX in patients who do not have diabetes showed transient effects on postoperative BG after TJA. The preoperative HbA1c level threshold (regardless of the administration or dosage of DEX) that increased the risk for the occurrence of FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl was 5.75% and 5.85%, respectively.