Intraoperative Dosing Of Dexamethasone In Type II Diabetic Patients Undergoing Orthopedic Procedures

The purpose of this quality improvement (QI) project was to identify trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing orthopedic procedures at a community hospital to determine impact of dosage level on postoperative glycemic response compared to preoperative levels and HgbA1C levels.
Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for effects on postoperative glycemic control. For this QI project, charts of type II diabetics receiving dexamethasone undergoing orthopedic procedures were reviewed. Data inclusion criteria were type II diabetics, procedures <4 hours, patients with a HbA1C reading 6.5-8.9%, patients who are non-pregnant, patients with an ASA classification of I, II, or III, & those not taking steroidal medications.
Dexamethasone dosage had a significant effect on the change of blood glucose levels, (t = 4.16, p < .001), with a higher dose leading to a greater increase in blood glucose (BG). There was a positive correlation between postoperative BG and both surgery length and age, meaning that the longer the surgery and the older the patient the higher the postop BG. Change in BG postoperatively had a negative correlation with HgbA1C, meaning that patients with a lower HgbA1C preoperatively had a greater increase in BG postoperatively. There was no significant increase in BG in doses of 0, 4, or 8 mg; but there was a significant increase in BG with a dexamethasone dose of 10 mg.
Results of the charts reviews found that small doses of dexamethasone did not increase postoperative BG significantly in type II diabetics. Larger doses of 10 mg had a significant increase in BG readings. Project results suggest further study and improvement interventions in dexamethasone dosing in diabetics.