The Impact of Intraoperative Intravenous Dexamethasone on Postoperative Outcomes in Patients with Diabetes Undergoing Posterior Cervical Decompression and Fusion

Study Design: Retrospective Cohort. Objective: This study aims to evaluate the impact of intraoperative dexamethasone on wound healing and opioid consumption in diabetic patients following PCDF. Background: Wound healing issues are a concern following posterior cervical decompression and fusion (PCDF). Consequently, the safety of intravenous dexamethasone during PCDF for diabetic patients remains controversial. Methods: Adult patients with type 2 diabetes mellitus (T2DM) who underwent PCDF (2018–2022) were identified through Structured Query Language search. Demographic/surgical characteristics and intraoperative, intravenous dexamethasone use were collected. Preoperative hemoglobin A1c and all in-hospital blood glucose readings were recorded. Glycemic variability was calculated using the coefficient of variation. Wound complications and delayed healing were documented. One year preoperative/postoperative opioid use was obtained from the Pennsylvania Prescription Drug Monitoring Program. In-hospital morphine milligram equivalents (MME) were obtained. Statistical analysis and linear regression were performed ( p =0.05). Results: One hundred five patients were included (46.7% received intraoperative dexamethasone). Dexamethasone patients were younger (61.4 vs. 65.4 y; P =0.042), but the 2 groups were otherwise demographically/surgically similar. Glycemic variability was higher in the dexamethasone group (30.1 vs. 23.3; P =0.019), although average in-hospital blood glucose was similar between groups. Linear regression did not identify dexamethasone as an independent predictor of glycemic variability when controlling for age, BMI, sex, and CCI. No other differences in surgical outcomes, wound infections, or delayed wound healing were found between groups. Preoperative and in-hospital opioid use were similar between groups. The association between dexamethasone and decreased total postoperative opioid consumption at 1 year trended toward significance (252 vs. 438 MMEs, P =0.086). Conclusion: Intraoperative intravenous dexamethasone administration during PCDF did not worsen postoperative glycemic control or increase the incidence of wound complications or other adverse outcomes among diabetic patients. Dexamethasone also did not definitively improve postoperative opioid consumption—further research is needed to evaluate this association with greater statistical power.