Benefits and Risks of Dexamethasone in Noncardiac Surgery

Myles, Paul S.; Corcoran, Tomás

doi:10.1097/aln.0000000000003898

Cited by 33 publications

(30 citation statements)

References 59 publications

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“…and P.D.P.). In the absence of an accepted definition of abdominal surgery and given the variety of different types of procedures included in prior investigations, [39][40][41][42] we selected a broad range of procedures performed within the abdomen, excluding transplant, trauma, obstetrics, and endoscopic procedures. We limited our study sample to cases that were manually reviewed for reporting to the National Surgical Quality Improvement Program (NSQIP), to ensure standardized ascertainment of postoperative complications.…”

Section: Cohort Identificationmentioning

confidence: 99%

Comparison of Electronic Frailty Metrics for Prediction of Adverse Outcomes of Abdominal Surgery

Liu

Kipnis

et al. 2022

JAMA Surg

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IMPORTANCE Electronic frailty metrics have been developed for automated frailty assessment and include the Hospital Frailty Risk Score (HFRS), the Electronic Frailty Index (eFI), the 5-Factor Modified Frailty Index (mFI-5), and the Risk Analysis Index (RAI). Despite substantial differences in their construction, these 4 electronic frailty metrics have not been rigorously compared within a surgical population.OBJECTIVE To characterize the associations between 4 electronic frailty metrics and to measure their predictive value for adverse surgical outcomes. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used electronic health record data from patients who underwent abdominal surgery from January 1, 2010, to December 31, 2020, at 20 medical centers within Kaiser Permanente Northern California (KPNC). Participants included adults older than 50 years who underwent abdominal surgical procedures at KPNC from 2010 to 2020 that were sampled for reporting to the National Surgical Quality Improvement Program. MAIN OUTCOMES AND MEASURESPearson correlation coefficients between electronic frailty metrics and area under the receiver operating characteristic curve (AUROC) of univariate models and multivariate preoperative risk models for 30-day mortality, readmission, and morbidity, which was defined as a composite of mortality and major postoperative complications. RESULTSWithin the cohort of 37 186 patients, mean (SD) age, 67.9 (female, 19 127 [51.4%]), correlations between pairs of metrics ranged from 0.19 (95% CI, 0.18-0.20) for mFI-5 and RAI 0.69 (95% CI, 0.68-0.70). Only 1085 of 37 186 (2.9%) were classified as frail based on all 4 metrics. In univariate models for morbidity, HFRS demonstrated higher predictive discrimination (AUROC, 0.71; 95% CI, 0.70-0.72) than eFI (AUROC, 0.64; 95% CI, 0.63-0.65), mFI-5 (AUROC, 0.58; 95% CI, 0.57-0.59), and RAI (AUROC, 0.57; 95% CI, 0.57-0.58). The predictive discrimination of multivariate models with age, sex, comorbidity burden, and procedure characteristics for all 3 adverse surgical outcomes improved by including HFRS into the models. CONCLUSIONS AND RELEVANCEIn this cohort study, the 4 electronic frailty metrics demonstrated heterogeneous correlation and classified distinct groups of surgical patients as frail. However, HFRS demonstrated the highest predictive value for adverse surgical outcomes.

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Section: Cohort Identificationmentioning

confidence: 99%

Comparison of Electronic Frailty Metrics for Prediction of Adverse Outcomes of Abdominal Surgery

Liu

Kipnis

et al. 2022

JAMA Surg

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“… 9 10 11 12 The potential analgesic effects of glucocorticoids as an adjuvant are probably due to their anti-inflammatory properties, including suppression of proinflammatory cytokines and induction of anti-inflammatory cytokines, reduction of prostaglandin synthesis, and with possible lowering of the excitability of nerve cells. 13 14 …”

Section: Introductionmentioning

confidence: 99%

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Gasbjerg

Hägi‐Pedersen

Lunn

et al. 2022

BMJ

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Objective To investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty. Design Randomised, blinded, placebo controlled trial with follow-up at 90 days. Setting Five Danish hospitals, September 2018 to March 2020. Participants 485 adult participants undergoing total knee arthroplasty. Intervention A computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia. Main outcome measures The primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain. Results 485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone. Conclusion Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. Trial registration Clinicaltrials.gov NCT03506789 .

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“…49,50 Dexamethasone given intravenously has also been shown to prolong regional block, and has an added benefit of providing excellent long-lasting prophylaxis for postoperative nausea and vomiting. [51][52][53][54] In addition, recent studies have shown that IV dexamethasone reduces break through pain reported with single shot blocks. 55 In regard to aesthetic plastic surgery applications, prolonged steroid use causes delayed wound healing, increased surgical site infections, and hyperglycemia.…”

Section: Steroidsmentioning

confidence: 99%

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

Schoenbrunner

Joshi

Janis

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods: A review study based on multimodal analgesia was conducted. Results: We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion: This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.

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Benefits and Risks of Dexamethasone in Noncardiac Surgery

Abstract: Dexamethasone is an effective antiemetic and improves patient quality of recovery. Meta-analyses and a recent large trial found no increase in risk of surgical site infection. Dexamethasone should be more widely used in perioperative practice.

Cited by 33 publications

References 59 publications

Comparison of Electronic Frailty Metrics for Prediction of Adverse Outcomes of Abdominal Surgery

Comparison of Electronic Frailty Metrics for Prediction of Adverse Outcomes of Abdominal Surgery

Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial

Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies

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