The purpose of this quality improvement project was to identify trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing genitourinary procedures at a full-service community hospital and to determine impact of dosage level on postoperative glycemic response compared to preoperative blood glucose levels. Dexamethasone is a corticosteroid that has many dose-dependent benefits when administered perioperatively to surgical patients. It is often withheld in the type II diabetic population out of concern for effects on postoperative glycemic control due to the side effect of hyperglycemia.
The method of this quality improvement project consisted of a retrospective chart review of patients with type II diabetes undergoing genitourinary procedures. Data inclusion criteria included patients who: are type II diabetics, had procedures that lasted less than four hours, had a documented preoperative hemoglobin A1C reading within the last twelve months ranging from 6.5-8.9%, are non-pregnant, are not taking oral steroidal medications, and had an ASA classification of I, II, or III.
Forty-nine charts were reviewed and overall there was no significant change in blood glucose in the postoperative period (t = 0.92, p = 0.361). The dose of dexamethasone (4, 8, or 10 mg) had no effect on the change in blood glucose levels (t =-1.14, p = 0.263). Additionally, changes in blood glucose were not found to be associated with age, HbA1C, or ASA status.
Dexamethasone administration for patients undergoing genitourinary procedures had no significant impact on blood glucose levels in the postoperative period. These findings may be a result of the shorter length of surgery, in that all 49 charts in this sample consisted of different cystoscopy procedures and had an average surgery length of 66 minutes. Further study is needed to help facilitate anesthesia provider’s decision-making for dexamethasone dosing in type II diabetics.