围手术期地塞米松对孤立性下肢长骨骨折固定的住院时间、围手术期结局和安全性的影响

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-20 DOI:10.1016/j.jcot.2025.103067

Tanios Dagher , Lohith Vatti , Diana Sosa , Jason Strelzow

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引用次数: 0

摘要

背景：在关节置换术的围手术期经常使用皮质类固醇，据报道可减少住院时间（LOS）和术后疼痛。恶心和阿片类药物的摄入。本研究旨在评估地塞米松对创伤患者行股骨/胫骨髓内钉（IMN）手术后LOS、术后结局和不良事件发生率的影响。方法回顾性队列研究于2018年5月至2022年5月在某城市一级创伤中心进行。201例年龄在16-65岁的孤立性股骨或胫骨骨折患者接受顺行或逆行股骨或胫骨内膜内固定治疗。排除了患有精神或身体残疾、GFR≤30、肝脏疾病、控制不良的糖尿病（HbA1C≥8）或3个月内使用类固醇的患者。开放性和闭合性骨折患者均被纳入研究。比较围手术期接受地塞米松治疗的患者（n = 88）和未接受地塞米松治疗的患者（n = 113）的术后LOS。次要结果与住院（如平均疼痛评分）、愈合时间、6个月不愈合发生率和90天手术部位感染率有关。分类结果采用Wilcoxon秩和分析，二分类数据采用卡方检验。结果两组间LOS差异无统计学意义（Dex 2.0±1.6 d, no Dex 2.1±1.3 d）。Dex组术后第0天的表面感染率（Dex 0 % [0/43], No Dex 13.5%[5/37]）、阿片类药物消耗（吗啡毫克量[MME]）（Dex 16.7±16.1,No Dex 21.1±17.4）和MME POD0-3平均值（Dex 24.5±16.5,No Dex 30.5±18.3）较低，但差异无统计学意义。其他次要结局无差异，包括愈合时间、疼痛评分、平均血糖和并发症发生率。尽管先前的文献支持围手术期给药地塞米松可降低LOS，但目前的研究表明，创伤患者接受胫骨或股动脉内固定后LOS无差异。然而，围手术期给药可以在不增加不良事件发生率的情况下提供短期益处。

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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.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.