Effects of Intraoperative Intravenous Dexamethasone on Postoperative Outcomes in Patients with Diabetes Undergoing Posterior Cervical Decompression and Fusion

Introduction: Wound healing issues are a primary concern following posterior cervical decompression and fusion (PCDF) due to poor blood flow. The safety of the use of intravenous (IV) dexamethasone, a highp otency long-acting glucocorticoid, during PCDF, remains controversial due to wound healing concerns. This study aims to evaluate the impact of intraoperative IV dexamethasone administration on wound healing and opioid consumption in diabetic patients following PCDF.

Methods: All adult patients who underwent a PCDF between 2018-2022 with a diagnosis of type 2 diabetes mellitus (T2DM) were identified via Structured Query Language (SQL) search and confirmed with manual chart review. Patient demographics, surgical characteristics, and intraoperative IV dexamethasone use were collected. Preoperative hemoglobin A1c levels and all in-hospital blood glucose readings were recorded, and glycemic variability was calculated. Wound complication data and delayed wound healing were documented. One year preoperative and postoperative opioid use were obtained from the Pennsylvania Prescription Drug Monitoring Program. In-hospital morphine milligram equivalents (MME) were obtained from an SQL search. Statistical analysis was performed and a p-value < 0.05 was considered statistically significant. Linear regression was conducted for glycemic variability as the dependent variable.

Results: Amongst the 105 patients with T2DM who underwent a PCDF between 2018-2022, 49 (46.7%) received IV dexamethasone intraoperatively. Those who received IV dexamethasone were younger (61.4 ± 9.35 vs. 65.4 ± 10.5 years; p=0.042) and had greater postoperative glycemic variability during their hospital stay (30.1 ± 22.1 vs. 23.3 ± 13.2; p=0.019) than those who did not receive IV dexamethasone. No other differences in demographics, surgical characteristics, surgical outcomes, wound infections, or delayed wound healing were found between groups. There was no difference in preoperative, in-hospital, and postoperative opioid use and MMEs. Linear regression analyses did not identify dexamethasone use to be a predictor of glycemic variability.

Conclusion : This study suggests the safety of perioperative dexamethasone use for PCDF regarding wound healing. Additionally, IV dexamethasone does not appear to decrease postoperative pain medication requirements. This indicates that dexamethasone should be utilized when clinically appropriate, but further research is needed to support its inclusion in standardized postoperative protocols.