Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial

Abdelmalak, Basem; Bonilla, Angela; Mascha, Ed; Maheshwari, Ankit; Tang, W.H. Wilson; You, Jing; Ramachandran, Mangakalaraip; Kirkova, Y; Clair, Daniel G.; Walsh, R. Matthew; Kurz, Andrea; Sessler, Daniel I.

doi:10.1093/bja/aet050

Cited by 61 publications

(21 citation statements)

References 47 publications

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“…This is important to acknowledge since dexamethasone itself may predispose to infection, which we have shown in previous facial fracture studies [11][12][13]. The same phenomenon was also shown by Abdelmalak et al who observed a higher rate of infections in vascular surgery patients with perioperatively administered dexamethasone, despite significantly decreased CRP levels [15]. We consider the use of dexamethasone in association with surgical treatment of facial fracture to be beneficial in selected patients.…”

Section: Discussionsupporting

confidence: 80%

“…As a negative consequence, however, surgical wound healing may be retarded, and the risk for surgical site infection may increase [11][12][13]. The postoperative increase in CRP may be attenuated by glucocorticoids [14,15]. How and to what extent perioperatively administered glucocorticoids affect postoperative CRP levels after surgery of facial fractures in particular remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Snäll

Törnwall

Suominen

et al. 2018

Oral Maxillofac Surg

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Snäll

Törnwall

Suominen

et al. 2018

Oral Maxillofac Surg

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“…Infectious complications were not evaluated. Next, secondary interim analyses of 381 patients enrolled in the Dexamethasone, Light Anesthesia and Tight Glucose Control (DeLiT) trial did not demonstrate a relationship between intensive insulin therapy and a composite morbidity and mortality endpoint [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative hyperglycemia is independently associated with infectious complications after non-cardiac surgery

et al. 2018

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BackgroundPerioperative hyperglycemia and its associated increase in morbidity and mortality have been well studied in the critical care and cardiac surgery literature. However, there is little data regarding the impact of intraoperative hyperglycemia on post-operative infectious complications in non-cardiac surgery.MethodsAll National Surgery Quality Improvement Program patients undergoing general, vascular, and urological surgery at our tertiary care center were reviewed. After integrating intraoperative glucose measurements from our intraoperative electronic health record, we categorized patients as experiencing mild (8.3–11.0 mmol/L), moderate (11.1–16.6 mmol/L), and severe (≥ 16.7 mmol/L) intraoperative hyperglycemia. Using multiple logistic regression to adjust for patient comorbidities and surgical factors, we evaluated the association of hyperglycemia with the primary outcome of postoperative surgical site infection, pneumonia, urinary tract infection, or sepsis within 30 days.ResultsOf 13,954 patients reviewed, 3150 patients met inclusion criteria and had an intraoperative glucose measurement. 49% (n = 1531) of patients experienced hyperglycemia and 15% (n = 482) patients experienced an infectious complication. Patients with mild (adjusted odds ratio 1.30, 95% confidence interval [1.01 to 1.68], p-value = 0.04) and moderate hyperglycemia (adjusted odds ratio 1.57, 95% confidence interval [1.08–2.28], p-value = 0.02) had a statistically significant risk-adjusted increase in infectious complications. The model c-statistic was 0.72 [95% confidence interval 0.69–0.74].ConclusionsThis is one of the first studies to demonstrate an independent relationship between intraoperative hyperglycemia and postoperative infectious complications. Future studies are needed to evaluate a causal relationship and impact of treatment.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0546-0) contains supplementary material, which is available to authorized users.

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“…Institutional review board approval (Cleveland Clinic Institutional Review Board, approval number 07-10) and written informed consent were obtained. We report a post hoc analysis of the results obtained during a previously published study in which we evaluated the effects of dexamethasone, light anaesthesia and tight glucose control on surgical outcomes in non-cardiac surgery patients-the Dexamethasone, Light Anaesthesia and Tight Glucose Control (DeLiT) Trial (Clinical trials.gov identifier: NCT00433251) 15,16 .…”

Section: Methodsmentioning

confidence: 99%

Effect of Statins on Insulin Requirements during Non-Cardiac Surgery

Turan

Egan

You

et al. 2014

Anaesthesia and Intensive Care

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Statins are thought to potentially impair glucose metabolism, increasing plasma glucose concentration. The effect of prolonged statin use on glucose metabolism among outpatients is thus well established. However, the impact of statin use on glucose concentrations and insulin requirements during surgery remains poorly characterised and may very well differ considering the substantial hyperglycaemic stress response to surgery. We conducted a study to test the hypothesis that patients taking statins preoperatively require more intraoperative insulin than non-users. We analysed 173 adults having major non-cardiac surgery who participated in the Dexamethasone, Light Anaesthesia and Tight Glucose Control Trial between 2007 and 2010. We compared statin and non-statin users on total amount of intraoperative insulin to maintain plasma glucose concentration within 4.4 to 6.1 mmol/l using the inverse propensity score weighting method. Sixty-seven patients were statin users and 106 were non-statin users. The estimated ratio of geometric means between the statin users and the non-users was 1.45 (95% confidence interval: 0.93, 2.26, statin versus non-statin, P=0.11). The total amount of intraoperative insulin usage did not differ significantly among patients taking different types of statins (P=0.50). While the total amount of intraoperative insulin used was not statistically different between the statin users and non-users, we observed a potentially important trend toward insulin resistance intraoperatively among statin users during major non-cardiac surgery. This result is consistent with non-operative settings and cardiac surgery. Further investigation is essential to determine whether this effect is real and, if so, determine which specific statins are more associated with insulin resistance.

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Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial

Abstract: Among our three interventions, dexamethasone alone reduced inflammation. However, no intervention reduced the risk of major morbidity or 1 yr mortality. TRIAL REGISTRATION IDENTIFIER: NCT00433251 at www.clinicaltrials.gov.

Cited by 61 publications

References 47 publications

Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Intraoperative hyperglycemia is independently associated with infectious complications after non-cardiac surgery

Effect of Statins on Insulin Requirements during Non-Cardiac Surgery

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