Dexamethasone, Glycemic Control, and Outcomes in Patients With Type 2 Diabetes Mellitus Undergoing Elective, Primary Total Joint Arthroplasty

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-05-15 DOI:10.1016/j.artd.2024.101391

Steven B. Porter MD , Jessica R. Wilson MD , Courtney E. Sherman MD , Launia J. White BS , Shalmali R. Borkar MPH , Aaron C. Spaulding PhD

{"title":"Dexamethasone, Glycemic Control, and Outcomes in Patients With Type 2 Diabetes Mellitus Undergoing Elective, Primary Total Joint Arthroplasty","authors":"Steven B. Porter MD , Jessica R. Wilson MD , Courtney E. Sherman MD , Launia J. White BS , Shalmali R. Borkar MPH , Aaron C. Spaulding PhD","doi":"10.1016/j.artd.2024.101391","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.</p></div><div><h3>Methods</h3><p>All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified. Propensity scores were calculated to match patients receiving or not receiving DEX. Primary outcomes were perioperative blood glucose levels and the incidence of hyperglycemia. Secondary outcomes were the amount of insulin administered, the occurrence of 30-day postoperative surgical site infections, hospital readmission, and mortality.</p></div><div><h3>Results</h3><p>After matching, we identified 1372 patients. DEX administration was associated with a significant increase in mean blood glucose levels in mg/dL on postoperative days (PODs) 0 to 2: POD 0 (28.4, 95% confidence interval [CI]: 24.6-32.1), POD 1 (14.4, 95% CI: 10.1-18.8), POD 2 (12.4, 95% CI: 7.5-17.2) when comparing patients who did or did not receive DEX. Additionally, patients receiving DEX, compared to patients who did not receive DEX, had increased odds of experiencing hyperglycemia on POD 0 (odds ratio: 4.0, 95% CI: 3.1-5.2). DEX was not associated with a significant difference in insulin administration, surgical site infections, hospital readmission, or mortality.</p></div><div><h3>Conclusions</h3><p>In our review of 1372 patients with propensity-matched type 2 diabetes mellitus undergoing elective, primary TJA, we found that DEX administration was associated with an increased risk of elevated mean glucose on POD 0-2, hyperglycemia on POD 0, but was not associated with an increase in total insulin dose administered nor occurrence of surgical site infections, hospital readmission, or mortality within 30 days of surgery in patients who received DEX compared to patients who did not receive DEX.</p></div><div><h3>Level of Evidence</h3><p>IV.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124000761/pdfft?md5=0c1c54ba06e8624a7078ccd92e8b3746&pid=1-s2.0-S2352344124000761-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344124000761","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA.

Methods

All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified. Propensity scores were calculated to match patients receiving or not receiving DEX. Primary outcomes were perioperative blood glucose levels and the incidence of hyperglycemia. Secondary outcomes were the amount of insulin administered, the occurrence of 30-day postoperative surgical site infections, hospital readmission, and mortality.

Results

After matching, we identified 1372 patients. DEX administration was associated with a significant increase in mean blood glucose levels in mg/dL on postoperative days (PODs) 0 to 2: POD 0 (28.4, 95% confidence interval [CI]: 24.6-32.1), POD 1 (14.4, 95% CI: 10.1-18.8), POD 2 (12.4, 95% CI: 7.5-17.2) when comparing patients who did or did not receive DEX. Additionally, patients receiving DEX, compared to patients who did not receive DEX, had increased odds of experiencing hyperglycemia on POD 0 (odds ratio: 4.0, 95% CI: 3.1-5.2). DEX was not associated with a significant difference in insulin administration, surgical site infections, hospital readmission, or mortality.

Conclusions

In our review of 1372 patients with propensity-matched type 2 diabetes mellitus undergoing elective, primary TJA, we found that DEX administration was associated with an increased risk of elevated mean glucose on POD 0-2, hyperglycemia on POD 0, but was not associated with an increase in total insulin dose administered nor occurrence of surgical site infections, hospital readmission, or mortality within 30 days of surgery in patients who received DEX compared to patients who did not receive DEX.

Level of Evidence

IV.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

地塞米松、血糖控制和接受择期初级全关节置换术的 2 型糖尿病患者的治疗效果

背景地塞米松（DEX）可减轻择期全关节成形术（TJA）患者的疼痛和术后恶心呕吐。我们研究了DEX对接受择期初诊TJA的2型糖尿病患者血糖控制和预后的影响。方法：确定了2016年1月至2021年12月期间在1个医院系统内的4个地点接受初诊择期TJA的所有2型糖尿病患者。计算倾向分数以匹配接受或不接受 DEX 的患者。主要结果是围手术期血糖水平和高血糖发生率。次要结果是胰岛素用量、术后 30 天手术部位感染发生率、再入院率和死亡率。与接受或未接受 DEX 的患者相比，接受 DEX 与术后第 0 天至第 2 天平均血糖水平（以 mg/dL 为单位）的显著升高有关：POD 0（28.4，95% 置信区间 [CI]：24.6-32.1）、POD 1（14.4，95% CI：10.1-18.8）、POD 2（12.4，95% CI：7.5-17.2）。此外，与未接受 DEX 的患者相比，接受 DEX 的患者在 POD 0 出现高血糖的几率增加（几率比：4.0，95% CI：3.1-5.2）。在胰岛素用量、手术部位感染、再次入院或死亡率方面，DEX 与显著差异无关。结论在对 1372 例接受择期、初诊 TJA 的倾向匹配 2 型糖尿病患者的研究中，我们发现，与未接受 DEX 的患者相比，接受 DEX 的患者在 POD 0-2 平均血糖升高、POD 0 血糖过高的风险增加，但接受 DEX 的患者在手术后 30 天内的胰岛素总用量、手术部位感染发生率、再入院率或死亡率均无增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.