Adverse side effects of dexamethasone in surgical patients

Background In the presence of an infection, the body starts an inflammation process. Dexamethasone is a steroid drug that slows down this inflammation process. Long-term treatment with steroid drugs has many side effects such as increased risk of infection, high blood pressure, and development of diabetes. During surgery, dexamethasone is given to the patient to reduce the risk of nausea and vomiting after surgery, to relieve pain, and to make the patient feel better. However, whether short-term treatment with dexamethasone leads to any adverse side effects is not known. Question The reviewers examined current evidence on the adverse side effects of short-term treatment with dexamethasone during surgery. They compared patients receiving dexamethasone to patients not receiving dexamethasone. They particularly looked at the number of infections after surgery and the number of wounds that did not heal well. Furthermore, as long-term treatment with steroids can lead to high blood sugar, they looked at the response of blood sugar within the first 24 hours postoperatively. What we found. Study characteristics: the reviewers searched four digital databases to find all relevant studies on this topic. The evidence is current to 29 January 2018. In total, they retrieved 37 relevant studies. One previously included study was recently retracted and subsequently excluded from this review. All studies included adults undergoing surgery. A total of 26 studies (4603 participants) had assessed the occurrence of infection after surgery, nine studies (1072 participants) had investigated delayed wound healing, and 10 studies (595 participants) had looked at the effect of dexamethasone on blood sugar. Key results: after pooling results, reviewers found that dexamethasone had no effect on the development of an infection after surgery, and that wounds healed equally well in both groups. However, the quality of the studies was moderate to low, which means thatmore studies are needed to support a definitive conclusion. Finally, the mean blood sugar of patients without diabetes receiving dexamethasone was slightly higher than that of patients not receiving dexamethasone (low-quality evidence). In patients with diabetes, this effect seemed to be larger. However, blood sugar was measured in only 74 patients with diabetes, which means that reviewers did not obtain a very accurate estimate. They qualified this as very low-quality evidence.