Effect of Preoperative Corticosteroids on Postoperative Glucose Control in Total Joint Arthroplasty

Background: Dexamethasone is a commonly used perioperative medication for the management of postoperative nausea and vomiting following total joint arthroplasty (TJA). However, concerns have been raised about its potential to cause hyperglycemia. This study aimed to investigate the impact of dexamethasone administration on glucose levels and complications in both diabetic and nondiabetic patients undergoing TJA. Methods: We performed a retrospective review of 1928 patients who underwent primary total knee and hip arthroplasty procedures at a large tertiary medical institution. Patients were divided into 2 groups based on whether they received preoperative dexamethasone. Postoperative blood glucose values and variability were measured, and data on complications were collected. We performed statistical analysis using descriptive analysis, multivariate logistic regression models, negative binomial regression, and a subset analysis to assess the impact of dexamethasone dose on postoperative glycemic control. Results: Preoperative dexamethasone did not significantly increase the mean glucose, fasting glucose, glucose variability, or 90-day complications in both the diabetic and nondiabetic groups. Nondiabetic patients who received dexamethasone had a significantly lower rate of intensive care unit admission (P < .01). Additionally, patients who received dexamethasone had a significantly shorter length of hospital stay compared to those who did not (P < .001). Conclusions: Preoperative dexamethasone administration is a safe and effective method for preventing postoperative nausea and vomiting in patients undergoing TJA without significant adverse effects on glucose levels, glucose variability, or infection rates in both diabetics and nondiabetics. Preoperative dexamethasone decreases postoperative length of stay.