Abstract
Background
The aims of this study were to assess the effect of perioperative dexamethasone on postoperative thyroid surgery recovery using measures of wound drainage volume and C-reactive protein (CRP) levels and leukocyte counts.
Materials and methods
From January to September 2014, healthy patients, aged between 18 and 65 years, had elective thyroid surgery in the tertiary hospital. Eligible patients were randomized into either group D (dexamethasone 0.1 mg/kg IV) or group S (saline IV) after anesthesia induction. At the end of surgery, a drainage tube was placed at the thyroid bed with a negative pressure ball connected outside the wound. Drainage fluids were collected after thyroid surgery. The fluid volume and the levels of C-reactive protein and leukocyte counts inside were analyzed. All patients were followed up for 1 month.
Results
The median total drainage in group D (n = 103) was 43 ml (IQR: 21–83 ml), and 68 ml (IQR: 35–104 ml) in group S (n = 111), P = 0.002. More patients in group D were discharged on postoperative day 2 (74.8% vs. 54.1%, P = 0.002). The CRP levels and leukocyte counts were much less in group D than in group S (P = 0.002 and P < 0.001, respectively). Two patients (one in each group) had wound infections 1 week after surgery that healed one additional week later.
Conclusions
One perioperative small dose of dexamethasone reduced wound drainage volume and inflammatory content after thyroid surgery, thereby possibly contributing to early recovery. The effects of dexamethasone have never been evaluated before under these conditions.
Registration number:
NCT02304250 (http://www.clinicaltrials.gov).
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References
Tarantino I, Warschkow R, Beutner U, Kolb W, Luthi A, Luthi C et al (2015) Efficacy of a single preoperative dexamethasone dose to prevent nausea and vomiting after thyroidectomy (the tPONV Study): a randomized, double-blind, placebo-controlled clinical trial. Ann Surg 262(6):934–940
Nasiri S, Shafag S, Khorgami Z, Sodagari N, Aminian A, Hedayat A (2013) Does corticosteroid have any beneficial effect on voice change after thyroidectomy? Am Surg 79(12):1258–1262
Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Lancione L et al (2013) Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial. JAMA Otolaryngol Head Neck Surg 139(5):471–478
Song YK, Lee C (2013) Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery. J Anesth 27(1):29–34
Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M (2011) Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck 33(6):840–846
Butt U, Ahmad R, Aspros D, Bannister GC (2011) Factors affecting wound ooze in total knee replacement. Ann R Coll Surg Engl 93(1):54–56
Samraj K, Gurusamy KS (2007) Wound drains following thyroid surgery. Cochrane Database Syst Rev 4:CD006099
Minami S, Sakimura C, Hayashida N, Yamanouchi K, Kuroki T, Eguchi S (2014) Timing of drainage tube removal after thyroid surgery: a retrospective study. Surg Today 44(1):137–141
Abdelmalak BB, You J, Kurz A, Kot M, Bralliar T, Remzi FH, Sessler DI (2018) The effects of dexamethasone, light anesthesia, and tight glucose control on postoperative fatigue and quality of life after major noncardiac surgery: a randomized trial. J Clin Anesth 29(55):83–91
Xu B, Ma J, Huang Q, Huang ZY, Zhang SY, Pei FX (2018) Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 26(5):1549–1556
Kainulainen S, Lassus P, Suominen AL, Wilkman T, Törnwall J, Thoren H, More Koivusalo AM (2018) Harm than benefit of perioperative dexamethasone on recovery following reconstructive head and neck cancer surgery: a prospective double-blind randomized trial. J Oral Maxillofac Surg Jun:1
Kim SG, Kim JG, Jang KM, Han SB, Lim HC, Bae JH (2017) Diagnostic value of synovial white blood cell count and serum C-reactive protein for acute periprosthetic joint infection after knee arthroplasty. J Arthroplasty 32(12):3724–3728
Zargar-Shoshtari K, Sammour T, Kahokehr A, Connolly AB, Hill AG (2009) Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. Br J Surg 96(11):1253–1261
Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS (2013) Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 110(2):191–200
De Palma M, Grillo M, Borgia G, Pezzullo L, Lombardi CP, Gentile I (2013) Antibiotic prophylaxis and risk of infections in thyroid surgery: results from a national study (UEC-Italian Endocrine Surgery Units Association). Updates Surg 65(3):213–216
Salem FA, Almquist M, Nordenström E, Dahlberg J, Hessman O, Lundgren CI, Bergenfelz A (2018) A nested case-control study on the risk of surgical site infection after thyroid surgery. World J Surg 42(8):2454–2461. https://doi.org/10.1007/s00268-018-4492-2
Acknowledgements
We appreciated the help from Mr. Rudolph Weitz who did English language editing and proof reading for the manuscript.
Funding
This study was funded by National Natural Science Foundation of China, Grant No. 81771933.
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Study conception was given by QZ. Study design was done by all authors. Participant recruitment was done by BW, QW, JL, CX. Data collection was done by HZ, QZ. Data analysis was given by HZ, YF. The first draft and the final paper were written by QZ, HZ.
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Statement of human rights was approved by Shanghai Jiaotong University affiliated Shanghai Sixth People’s Hospital ethics committee.
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Informed consent was obtained from all individual participants included in the study.
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Zhang, H., Lu, J., Wu, Q. et al. A Perioperative Small Dose of Dexamethasone Enhances Postoperative Recovery by Reducing Volume and Inflammatory Contents in Wound Drainage After Thyroid Surgery: A Double-Blinded, Randomized, Prospective Study. World J Surg 43, 1721–1727 (2019). https://doi.org/10.1007/s00268-019-04986-0
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DOI: https://doi.org/10.1007/s00268-019-04986-0