Perioperative medicine & outcomes
Preoperative high dose of dexamethasone in emergency laparotomy: randomized clinical trial
Authors' conclusion
A single preoperative high dose of intravenous dexamethasone significantly reduces the inflammatory response after emergency laparotomy and is associated with enhanced recovery and improved outcome.
Study context
- Population
- Patients undergoing emergency laparotomy (intestinal obstruction or perforated viscus)
- Participants
- 120 patients
- Comparison
- Preoperative IV dexamethasone 1 mg/kg vs placebo
- Primary endpoint
- C-reactive protein
- Follow-up
- POD 1
Methodological detailsdouble-blinded, placebo-controlled, stratified by surgical pathology
- Double-blinded
- Placebo-controlled
- Stratified by surgical pathology
Primary result
As reported in the abstract
Mean difference
49 mg/l
95% CI 13–85
P = 0.015
By group
Dexamethasone vs Placebo
mean difference 49 mg/l (95% CI 13–85); P = 0.015
Secondary outcomes
C-reactive protein, intestinal obstruction (subgroup) · POD 1
P = 0.002
C-reactive protein, perforated viscus (subgroup) · POD 1
P = 0.035
| Outcome | Dexamethasone | Placebo | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Mortality · 90 days | 7% | 23% | 0.33 (0.11–0.93) | P = 0.023 | |
| 0.10.31310Relative risk (log scale) |
Postoperative recovery
- Improved recovery with dexamethasone (better haemodynamics, better pulmonary function, less fatigue, earlier mobilization)
Safety
| Outcome | Dexamethasone | Placebo | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Postoperative major complications | 27% | 45% | 0.62 (0.37–1.00) | P = 0.032 | |
| 0.20.5125Relative risk (log scale) |
Original publication
Preoperative high dose of dexamethasone in emergency laparotomy: randomized clinical trial. Br J Surg. Published 19 July 2024. doi:10.
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