The safety and efficacy of dexamethasone in the perioperative management of glioma patients

Abstract

OBJECTIVE In this single-institution retrospective cohort study, the authors evaluated the effect of dexamethasone on postoperative complications and overall survival in patients with glioma undergoing resection. METHODS A total of 435 patients who underwent resection of a primary glioma were included in this retrospective cohort study. The inclusion criterion was all patients who underwent resection of a primary glioma at a tertiary medical center between 2014 and 2019. RESULTS The use of both pre- and postoperative dexamethasone demonstrated a trend toward the development of postoperative wound infections (3% vs 0% in single use or no use, p = 0.082). No association was detected between dexamethasone use and the development of new-onset hyperglycemia (p = 0.149). On multivariable Cox proportional hazards analysis, dexamethasone use was associated with a greater hazard of death (overall p = 0.017); this effect was most pronounced for preoperative (only) dexamethasone use (hazard ratio 3.0, p = 0.062). CONCLUSIONS Combined pre- and postoperative dexamethasone use may increase the risk of postoperative wound infection, and dexamethasone use, specifically preoperative use, may negatively impact survival. These findings highlight the potential for serious negative consequences with dexamethasone use.

Risk factors for meningitis after craniotomy for gliomas: A 8-year experience from a tertiary medical center

“…In comparison to previous literature 9,50,51 , this study did not conclude that diabetes and the use of steroids are risk factors for postoperative meningitis. This difference in ndings may be due to the higher rate of corticosteroid usage and the lower number of diabetes patients in our study.…”

Evaluating the safety of perioperative dexamethasone treatment: A retrospective analysis of a single center pediatric low‐grade glioma cohort

“…Clinical data lately likewise raised the question regarding the safety of DM treatment for symptom control in glioma patients, as in a retrospective analysis, Medikonda et al showed that perioperative dexamethasone use may negatively impact survival in adult glioma patients. This effect was most pronounced in patients receiving only preoperative dexamethasone 20 . Likewise, a meta‐analysis including 2230 adult glioblastoma patients partly confirmed an association of DM application with poor treatment outcome 21 .…”

“…This effect was most pronounced in patients receiving only preoperative dexamethasone. 20 Likewise, a meta-analysis including 2230 adult glioblastoma patients partly confirmed an association of DM application with poor treatment outcome. 21 However, there is no significant data derived from pediatric cohorts available to this day.…”

“…While the effects of DM on cell growth and OS in adult glioma remains controversial, independent studies, as well as a meta-analysis partly confirmed association of a poor treatment outcome with use of DM in adult glioma. 20,21 To our knowledge, no significant clinical data regarding the impact of DM on progression-free survival (PFS) and OS in pLGG has been published to this day.…”

Dexamethasone Use in Perioperative Neuroscience: Boon or Bane, or Both?

“…In the DEX-CSDH trial, 5 the risk of any infection in patients receiving dexamethasone was 6.4% compared with 1.1% in the placebo group. Medikonda et al 11 found that the use of pre and postoperative dexamethasone in glioma patients was associated with a trend towards the development of SSIs (3% vs 0% in single or no use, P = 0.082) and worse outcomes. In contrast, in the larger, multicenter PADDI trial, in which 7.4% of participants were neurosurgical cases, dexamethasone use was noninferior to placebo for SSIs within 30 days of surgery 12 .…”