{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:20:11Z","timestamp":1788808811039,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF21SA0073760"],"award-info":[{"award-number":["NNF21SA0073760"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Perioperative high\u2010dose steroids are widely used to reduce postoperative inflammation, pain, and complications but remain controversial in patients with insulin\u2010treated diabetes due to concerns about hyperglycemia and infections. This study aimed to examine the use of perioperative high\u2010dose steroids and its effect on discharge glucose concentration, length of stay (LOS), and 30\u2010day readmissions in insulin\u2010treated patients with diabetes undergoing fast\u2010track hip or knee arthroplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a prospective observational study in patients with insulin\u2010treated diabetes undergoing fast\u2010track hip or knee arthroplasty across eight Danish centers. Patient demographics, including diabetes treatments, perioperative steroid, discharge blood glucose concentration, LOS, and 30\u2010day readmissions were prospectively extracted from the electronic health records through chart review. Our primary outcome was differences in mean discharge blood glucose concentration between patients with insulin\u2010treated diabetes receiving perioperative high\u2010dose steroid and no\/antiemetic steroid. Secondary outcomes included the fraction with a LOS &gt;\u20092 and 30\u2010day readmissions between the groups. As a sensitivity analysis, discharge blood glucose concentration was compared between the insulin\u2010treated patients and a propensity\u2010score matched cohort of non\u2010insulin\u2010treated patients with diabetes all receiving high\u2010dose steroids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 292 registered patients with insulin\u2010treated diabetes, 64% received high\u2010dose steroids. Median discharge blood glucose was 11.0\u2009mmol\/L [IQR 8.9\u201313.5] in the high\u2010dose steroid group versus 9.7\u2009mmol\/L [IQR 7.4\u201312] in the no\/antiemetic steroid group (<jats:italic>p<\/jats:italic>\u2009=\u20090.011). LOS &gt;\u20092\u2009days occurred in 10.1% (95% CI: 6.6\u201315.3) of the high\u2010dose group and 15.2% (95% CI: 9.6%\u201323.3%) of the no\/antiemetic steroid group (<jats:italic>p<\/jats:italic>\u2009=\u20090.200). The 30\u2010day readmission rates were 8% (95% CI: 4.8\u201313) and 8.3% (95% CI: 4.3\u201315.6), respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.923). Compared to propensity\u2010matched patients with non\u2010insulin\u2010treated diabetes receiving high\u2010dose steroids, patients with insulin\u2010treated diabetes had a 2.1\u2009mmol\/L (95% CI: 1.3\u20132.8) higher mean discharge blood glucose concentration (<jats:italic>p<\/jats:italic>\u2009=\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Glucose levels at discharge were slightly, but significantly higher in insulin\u2010treated patients with diabetes receiving high\u2010dose steroids compared to those receiving no\/antiemetic doses and to non\u2010insulin treated diabetes patients receiving high\u2010dose steroids. However, there was no increase in fraction with LOS &gt;\u20092\u2009days or 30\u2010day readmissions in the patients having high\u2010dose steroids. Despite increased discharge glucose concentration, this suggests no evident safety concerns using high\u2010dose steroids in insulin\u2010treated diabetes patients having fast\u2010track arthroplasty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>This multicenter study addresses the debated use of a high\u2010dose perioperative glucocorticoid in insulin\u2010treated patients with diabetes undergoing fast\u2010track arthroplasty. Despite modestly increased discharge glucose levels, no safety signals were observed regarding length of stay or readmissions. These findings support cautious use of a single high\u2010dose perioperative glucocorticoid in this population. However, larger randomized studies are needed to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.70100","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T07:49:35Z","timestamp":1753170575000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perioperative High\u2010Dose Steroid in Insulin\u2010Treated Patients With Diabetes Undergoing Fast\u2010Track Hip and Knee Arthroplasty: Impact on Length of Stay and Discharge Blood Glucose Levels"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0288-0916","authenticated-orcid":false,"given":"Luma","family":"Mahmoud Issa","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Hvidovre University Hospital  Copenhagen Denmark"},{"name":"Center for Fast\u2010Track hip and Knee Replacement  Copenhagen 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Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0625-5691","authenticated-orcid":false,"given":"Claus","family":"Varnum","sequence":"additional","affiliation":[{"name":"Center for Fast\u2010Track hip and Knee Replacement  Copenhagen Denmark"},{"name":"Department of Orthopaedic Surgery Lillebaelt Hospital\u2014Vejle  Vejle Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Center for Fast\u2010Track hip and Knee Replacement  Copenhagen Denmark"},{"name":"Department of Orthopaedic Surgery Aalborg University Hospital  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3405-7147","authenticated-orcid":false,"given":"Mikkel Rathsach","family":"Andersen","sequence":"additional","affiliation":[{"name":"Center for Fast\u2010Track hip and Knee Replacement  Copenhagen 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