Conference Coverage

Is Intraoperative Dexamethasone Safe for Patients with Diabetes?

Kate Young

Key Highlights:

  • One-time intraoperative dexamethasone administration (4-12 mg IV) was not associated with an increased risk of surgical site infections (SSIs) in patients with diabetes.
  • Across five studies, no significant difference in wound infection or healing outcomes was observed between dexamethasone and control groups.
  • Despite diabetic patients having higher overall SSI risk, dexamethasone use did not contribute to increased infection rates.

A study presented by Monica Bierschenk, BSN, RN, and colleagues at the American Association of Nurse Anesthesiology 2025 Annual Congress found that administering a single dose of intravenous (IV) dexamethasone (4-12 mg) intraoperatively for PONV prophylaxis does not increase the risk of surgical site infections (SSIs) in patients with diabetes mellitus (DM). A synthesis of data from five studies concluded there was no statistically significant association between dexamethasone administration and the development of SSIs within 90 days post-surgery. The findings support its safety profile even in a population already at increased risk for postoperative complications.

The clinical significance of this research lies in its focus on a vulnerable group—patients with DM—who often face elevated perioperative risk. Dexamethasone is widely used to prevent PONV but is also known to cause transient hyperglycemia, a concern in diabetic patients due to the potential for impaired wound healing. The study aimed to address this knowledge gap by analyzing available evidence around dexamethasone use and wound outcomes in this population.

A literature review was conducted using databases such as Embase, PubMed, and Web of Science, with search terms including "dexamethasone," "perioperative," and "diabetes mellitus." Only studies published in English within the past 10 years were considered. Inclusion criteria focused on adult patients with type 1 or type 2 DM undergoing non-cardiac, non-emergent surgeries and receiving a single intraoperative dose of IV dexamethasone (4-12 mg). Studies had to report on SSIs occurring within 90 days post-surgery. Ultimately, five studies (including RCTs and retrospective cohort studies) met the criteria and were included.

Across all five studies, no increase in wound infection rates or negative impact on healing was found among diabetic patients who received dexamethasone. For example, in a 2023 systematic review and meta-analysis by Pang et al. that included more than 4600 patients, the odds ratio for SSI in dexamethasone-treated patients was 0.797 (95% CI: 0.578-1.099, P = .166), indicating no significant risk elevation. Other retrospective cohort studies reported similarly nonsignificant differences in SSI rates between dexamethasone and control groups, such as Huffman et al. (16.0% vs. 16.9%, P = .882) and Porter et al. (2.3% vs. 2.8%, P = .612). Although patients with diabetes did have a higher overall incidence of prosthetic joint infection, this was not attributed to dexamethasone use.

Limitations of the review included the predominance of retrospective data, lack of standardized dexamethasone dosing across studies, and unknown mechanisms by which dexamethasone might influence wound healing or glycemic response.

“Dexamethasone, when given intraoperatively for PONV prophylaxis, is not associated with an increased risk of developing an SSI within 90 days of surgery in the diabetic population,” Bierschenk and colleagues concluded.

Reference:
Bierschenk M, Crow C. Impact of one-time dexamethasone dose on surgical healing in patients with diabetes mellitus. Presented at: American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress; August 9-13, 2025; Nashville, TN. https://www.aana.com/premier-event/annual-congress/