Perioperative dexamethasone: Effects on length of stay, perioperative outcomes, and safety in isolated lower extremity long bone fracture fixation.

BACKGROUND

Corticosteroids are frequently administered perioperatively during arthroplasty procedures with reported reductions in length of stay (LOS), postoperative pain & nausea, and opioid consumption. This investigation aims to evaluate the effects of perioperative dexamethasone on LOS, post-operative outcomes, and adverse event rates for trauma patients undergoing femoral/tibial intramedullary nailing (IMN).

METHODS

A retrospective cohort study was conducted at an urban Level 1 Trauma center between May 2018 and May 2022. 201 patients aged 16-65 with isolated femur or tibia fractures treated with antegrade or retrograde femoral or tibial IMN underwent chart review. Those with mental or physical disability, GFR <30, liver disease, poorly controlled diabetes (HbA1C ≥ 8), or steroid use within 3 months were excluded. Patients with both open and closed fractures were included in the study. LOS postoperatively was compared between patients who received dexamethasone perioperatively (Dex, n = 88) and those who did not (No Dex, n = 113). Secondary outcomes pertained to inpatient admission (e.g. average pain score), time to union, incidence of nonunion by 6 months, and 90-day surgical site infection rate. Categorical outcomes were analyzed using Wilcoxon rank-sum analysis and dichotomous data using chi-square testing.

RESULTS

There was no difference in LOS between groups (Dex 2.0 ± 1.6 days, No Dex 2.1 ± 1.3 days). While the Dex group had lower rates of superficial infection (Dex 0 % [0/43], No Dex 13.5 % [5/37]), opioid consumption (morphine milligram equivalent [MME]) on postoperative day 0 (Dex 16.7 ± 16.1, No Dex 21.1 ± 17.4), and MME POD0-3 average (Dex 24.5 ± 16.5, No Dex 30.5 ± 18.3), these results were not statistically significant. There were no differences in other secondary outcomes, including time to union, pain scores, average blood glucose, and complication rates.

CONCLUSION

Despite previous literature supporting a reduction in LOS associated with perioperative dexamethasone administration, the current study demonstrated no difference in trauma patients undergoing tibial or femoral IMN. However, perioperative administration may provide short-term benefits without increasing adverse event rate.