Efficacy of a single preoperative low-dose dexamethasone on 1-year mortality in geriatric femoral intertrochanteric fracture patients after internal fixation surgery: A randomized, placebo-controlled clinical trial

Background: The prognosis of geriatric intertrochanteric fractures (ITF) remains unfavorable even with early surgical treatment due to the fragility associated with aging and stress induced by the fracture. Low-dose dexamethasone has been proposed to improve short-term survival. However, whether a single preoperative dose of low-dose dexamethasone improves survival one year after surgery remains unknown. Methods: This single-center, single-blinded, randomized, placebo-controlled study was conducted at Guangzhou First People’s Hospital. A total of 160 participants admitted between June 2020 and October 2022 were randomly assigned to the dexamethasone group or the placebo group (80 participants per group). The dexamethasone group received 10 mg (2 mL) of dexamethasone and the placebo group received 2 mL of saline intravenously 30 min before surgery. The primary outcome was the prespecified 1-year mortality after surgery. Secondary outcomes included adverse events during hospitalization, Barthel activity of daily living (BADL) score and Parker–Palmer score (PPS) at 30 days, 90 days, 180 days, and 1 year after surgery. Statistical analyses included Studen’s t -test or Mann–Whitney U test for quantitative variables, chi-squared test for categorical variables, and Log-rank test for survival differences. Results: All participants completed the follow-up. A total of 41 participants died within one year after surgery. There were 15 deaths (18.8%) in the dexamethasone group and 26 deaths (32.5%) in the placebo group (hazard ratio [HR] = 0.51, 95% confidence intervals [CI] = 0.27–0.96, P = 0.04). There were no significant differences in the risk of infection events or hyperglycemia during hospitalization between the dexamethasone and placebo groups ( P >0.05). Although survivors in the dexamethasone group had higher BADL and PPS scores at 30 days, 90 days, 180 days, and 1 year after surgery compared to those in the placebo group, no significant differences were found between the groups at these time points ( P >0.05). Conclusions: A single preoperative low-dose dexamethasone administration reduces 1-year mortality in geriatric ITF patients following internal fixation surgery and may positively impact functional recovery in survivors. Trial registration: Chinese Clinical Trial Registry, ChiCTR2200055281.