Background and Goal of Study:  As part of the fast track total Hip or Knee Arthroplasty (THA/TKA) in our hospital, patients receive dexamethasone 0,15 mg/kg/iv preoperatively. Steroids or glucocorticoids provides effective pain relief by reducing inflammation, reduces PONV and LOS in hospital. The aim of this study is to evaluate the influence of 0,15 mg/kg/iv  dexamethasone on serum glucose levels in patients with diabetes in the early postoperative phase in fast track THA/TKA surgery. 

Materials and Methods: 
In this retrospective cohort study, serum blood glucose levels in the first 24 hours after surgery were analyzed. All patients underwent THA or TKA in 2016 or 2017 and received 0,15 mg/kg dexamethasone intravenously. Data on demographics, surgery and outcomes were retrieved from their medical records. The hospital medical ethical board granted permission for the study.

Results: 
A total of 214 patients were analyzed, mean age was 71.2 ± 8.21 years,  60,7% were female, mean ASA score was 2.38 ± 0.50, 63.1% received TKA and 36.9% THA. Mean blood glucose before surgery was 8.08 ± 2.07  mmol/l. General Linear Models for repeated measures indicated a significant increase in blood glucose levels after surgery (p<.001) with a clear peak 4-8 hours post-surgery (M = 17.33  ± 4.65). After 24 hours, blood glucose levels turned to baseline levels. The increase in blood glucose levels was significantly related to interventions for high blood glucose levels (e.g. additional measurements, change in insulin). Such interventions were needed in 51.6 % of the patients.

Conclusion:

Our study suggests that by providing lower incidence of postoperative nausea and vomiting and less postoperative acute pain, dose systemic steroid plays a critical role in rapid recovery to TKA and THA. The preliminary results also show the superior possibility of systemic steroid in functional rehabilitation and inflammation control. In diabetes patients the use of dexamethasone increases blood glucose levels temporarily, which needs interventions in diabetes regime in about half of the patients. However, in light of the advantages this seems acceptable and changes in our glucose and insulin policy are advised. Well powered randomized clinical trials are needed to investigate the safety and dose–response relationship.

08 / The influence of perioperative systemic steroid administration in diabetic patients receiving fast track primary Total  Hip or Knee Arthroplasty. Results of a retrospective study.
