Intraoperative high dose dexamethasone is associated with clinically relevant postoperative pancreatic fistula: a retrospective cohort study.

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-08-28 DOI:10.1016/j.hpb.2025.08.008

Scott C Fligor, John Christopher Polanco-Santana, Ashley Lanys, Joao P G Kasakewitch, Maximilian S Schaefer, Umut Sarpel, Tara S Kent

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引用次数: 0

Abstract

Background: Intraoperative dexamethasone is routinely administered to prevent postoperative nausea and vomiting. Limited research has investigated dexamethasone safety during pancreatectomy. We investigated whether intraoperative dexamethasone administration affects clinically relevant postoperative pancreatic fistula (CR-POPF) development.

Methods: We performed a retrospective cohort study of patients undergoing pancreatoduodenectomy or distal pancreatectomy at a single academic institution (2014-2021). Impact of dexamethasone administration on CR-POPF (ISGPF Grade B/C) was assessed using multivariable logistic regression and inverse probability weighted regression analysis.

Results: 503 patients were included (pancreatoduodenectomy n=307; distal pancreatectomy n=196). Of these, 59 (11.7%) received low-dose dexamethasone (4-6 mg) and 100 (19.9%) received high-dose dexamethasone (8-10 mg). High dose dexamethasone (aOR:2.47, 95% CI:1.40-4.36), but not low dose dexamethasone (aOR:1.32, 95% CI:0.61-2.86), was associated with increased odds of CR-POPF. After inverse probability weighted regression adjustment, the average treatment effect of high dose dexamethasone on CR-POPF was +11.1% (95% CI:1.7-20.3%) above the baseline risk of 12.5% (95% CI:9.0-16.1%) in patients receiving no dexamethasone.

Discussion: Intraoperative administration of high dose (8-10mg) dexamethasone was associated with a meaningfully increased risk of CR-POPF after pancreatectomy. High-dose dexamethasone is a modifiable risk factor for CR-POPF and should be avoided unless there is clear clinical indication.

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术中大剂量地塞米松与临床相关的术后胰瘘相关：一项回顾性队列研究

背景：术中常规给予地塞米松以防止术后恶心和呕吐。有限的研究调查了地塞米松在胰腺切除术中的安全性。我们研究术中给药地塞米松是否影响临床相关的术后胰瘘（CR-POPF）的发展。方法：我们对在单一学术机构（2014-2021年）接受胰十二指肠切除术或远端胰腺切除术的患者进行了回顾性队列研究。采用多变量logistic回归和逆概率加权回归分析评价地塞米松给药对CR-POPF （ISGPF分级B/C）的影响。结果：共纳入503例患者（胰十二指肠切除术307例，远端胰切除术196例）。其中59例（11.7%）接受低剂量地塞米松（4-6 mg）治疗，100例（19.9%）接受高剂量地塞米松（8-10 mg）治疗。高剂量地塞米松（aOR:2.47, 95% CI:1.40-4.36）与CR-POPF发生率升高相关，而低剂量地塞米松（aOR:1.32, 95% CI:0.61-2.86）与CR-POPF发生率升高无关。经逆概率加权回归调整后，大剂量地塞米松对CR-POPF的平均治疗效果比未接受地塞米松治疗的基线风险12.5% （95% CI:9.0-16.1%）高+11.1% （95% CI:1.7-20.3%）。讨论：术中给药高剂量（8-10mg）地塞米松与胰腺切除术后CR-POPF风险显著增加相关。大剂量地塞米松是CR-POPF可改变的危险因素，除非有明确的临床指征，否则应避免使用。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).