Peri-Op Corticosteroid Injection Reduces Hospital Length of Stay, Pain & PONV in TKA & THA Patients .
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Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
J Arthroplasty. 2021 Mar;36(3): 1168-1186.Seventeen randomized controlled trials with 1957 patients undergoing unilateral total hip and knee arthroplasty were included in this meta-analysis comparing peri-operative intravenous corticosteroid (any type; n=1144) to control (saline, ramosteron, ondansetron; n=813) The primary pooled outcome of interest was length of hospital stay. Secondary outcomes of interest included pain at rest and during activity, incidence of complications, blood glucose levels, inflammatory markers (C-reactive protein [CRP]), and the incidence of post-operative nausea and vomiting (PONV). Pain at rest and during activity were measured a days 0, 1 and 2 post-surgery, and PONV was measured at days 1 and 2 after surgery. Sub-group analyses was conducted for all outcomes by high and low dosage of corticosteroids. In addition, a subgroup analysis by additional corticosteroid administration after 24-hours compared to none was also conducted for pain at rest and during activity and PONV at post-operative day 2. Pooled results revealed that the primary outcome, length of hospital stay, was statistically significantly reduced in the corticosteroid group compared to the control (MD -0.39 [95%CI -0.61,-0.18]). Furthermore, pain at rest and during activity were statistically significantly favored in the corticosteroid group compared to the placebo group at post-operative days 0 (MD -0.99 [95%CI -1.55, -0.42]; MD -1.99 [95%CI -2.2, -0.69], respectively), post-operative day 1 (MD-0.63 [95%CI -0.9, -0.36]; MD -1.47 [95%CI -2.15, -0.79], respectively), and post-operative day 2 (MD -0.26 [95%CI -0.47, -0.05]; MD -0.60 [95%CI -0.98, -0.22], respectively). Similarly, pooled PONV at post-surgical days 1 and 2 and pooled CRP levels were statistically significantly in favour of the corticosteroid group. However, pooled results revealed no statistically significant difference between the corticosteroid and placebo group for the incidence of complications including infection, venous thromboembolism, and gastrointestinal hemorrhage (p>0.05 for all). Pooled blood glucose levels were statistically significantly higher in the corticosteroid group vs placebo (MD 5.30 [95%CI 2.69, 7.9]).
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