Although dexamethasone is often used to prevent nausea and vomiting after surgery, concerns have been raised that it may increase the risk of surgical-site infection. A new study from researchers in New Zealand and Australia published on May 6 in the New England Journal of Medicine showed that dexamethasone was noninferior to placebo in the incidence of surgical-site infection within 30 days after nonurgent, noncardiac surgery.
More than 8,600 adult patients who were undergoing nonurgent, noncardiac surgery of at least 2 hours’ duration, with a skin incision length longer than 5 cm and a postoperative overnight hospital stay, were randomly assigned to receive 8 mg of I.V. dexamethasone or a placebo while under anesthesia. Randomization was stratified according to diabetes status and trial center, and the primary outcome was surgical-site infection within 30 days after surgery.
Of the 8,678 patients included in the primary analysis, surgical-site infection occurred in 8.1% of patients receiving dexamethasone and in 9.1% receiving a placebo. The results for patients with diabetes were similar to those of the primary analysis. Postoperative nausea and vomiting in the first 24 hours after surgery occurred in 42.2% of patients in the dexamethasone group and in 53.9% in the placebo group, while hyperglycemic events in patients without diabetes occurred in 0.6% in the dexamethasone group and in 0.2% in the placebo group.
The authors concluded that a single dose of dexamethasone can be used safely to prevent postoperative nausea and vomiting without excess risk for infection.