1 Department of Surgery and Orthopedic, Ascension Genesys Medical Center, Grand Blanc, MI, USA 2 Department of Academic Research, Ascension Genesys Medical Center, Grand Blanc, MI, USA Corresponding Author: Tarik J. Wasfie, MD, Department of Surgery and Orthopedic, Ascension Genesys Medical Center, Grand Blanc, MI 48439, USA. Email: twasfie@gmail.com The American Surgeon 00(0) 1–5 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0003134820947391 journals.sagepub.com/home/asu Efficacy of Preoperative Usage of Dexamethasone in Diabetic Patients Undergoing Total Hip or Knee Arthroplasty for Control of Nausea and Vomiting Tarik J. Wasfie, MD 1 , Jessica Groton, DO 1 , Natalia Cwalina, MD 1 , Jennifer R. Hella, MPH 2 , and Kimberly Barber, PhD 2 Abstract Background: Dexamethasone has been used in surgical patients to decrease nausea, vomiting, and postoperative pain. However, it is not well studied how much dexamethasone complicates glucose control in diabetic patients and whether this leads to poor surgical outcomes. Methods: We analyzed 256 diabetic patients who underwent elective hip and knee arthroplasty and evaluated the groups that received dexamethasone intraoperatively (201 patients), those who received dexamethasone postopera- tively (237 patients), and those who did not receive the steroid intraoperatively (55 patients) and postoperatively (19 patients). Results: 256 diabetic patients were included in the study. The mean age of the group was 68.7 (SD ± 9-10) years. Patients were divided into 123 males (48%) and 133 females (52%). 174 (78%) patients had a total knee replacement operation, and 82 (32%) patients had total hip replacement operation. The mean hemoglobin A1c was 6.728 (SD ± 0.99). The mean ASA score was 2.86 (SD ± 0.38). 201 (78.5%) patients received preoperative or intraoperative dexamethasone, and 237 (92.6%) patients received it postoperatively. The mean blood glucose for all patients raised from 131.9 to 172.2 mg/dL (P = .012) postoperatively, 206.1 mg/dL in the first 24 hours, and 146.2 mg/dL (P = .39) in the second postoperative day. The change was significant in patients who had poorly controlled diabetes (P < .01) preoperatively. There was no significant difference in our study regarding dexamethasone use and effect on postoperative nausea (P = 1.0) and vomiting (P = .52). There was an improvement in pain scores in the patients who received dexamethasone postoperatively which was statistically signifi- cant (P = .054). Conclusion: Dexamethasone use in diabetic patients for control of postoperative nausea and vomiting in those un- dergoing elective total knee and hip arthroplasty had a negative impact on glycemic control specifically in those with poorly controlled diabetes and should be avoided. Keywords dexamethasone, post operative nausea and vomiting, diabetic patients post surgery Article Introduction Dexamethasone is a strong glucocorticoid with a half-life of 36-72 hours. It induces hepatic gluconeogenesis, increases insulin resistance, and may be associated with poor surgical outcomes in postsurgical patients. 1 The use of dexamethasone intraoperatively by the anesthesiologist as recommended by the Society of Ambulatory Anesthesia 2 to reduce postoperative nausea and vomiting for those patients undergoing elective