Association Between Preoperative Single Dose of Dexamethasone and Postoperative Outcomes in Elderly Patients with Gastric Cancer
Abstract
Background Optimizing postoperative recovery for elderly gastric cancer patients is of great clinical significance. This retrospective cohort study aimed to explore the association between preoperative use of dexamethasone and postoperative outcomes in elderly patients undergoing gastric cancer resection. Methods In this retrospective cohort study, elderly patients who underwent gastric cancer resection were enrolled. Baseline and perioperative data including use of dexamethasone for antiemetic purpose were collected. Patients were divided into control group (no dexamethasone), low-dose group (< 10 mg) and high-dose group (≥ 10 mg) based on the dose of dexamethasone administered preoperatively on the discretion of anesthesiologists. The primary endpoint was postoperative length of hospital stay (pLOS), defined as the duration from surgery to initial discharge (prolonged pLOS referred to pLOS ≥ median pLOS of all patients). The association between perioperative dexamethasone use and prolonged pLOS were analyzed with multivariable logistic regression models. Dose-response trend test and sensitivity analysis were conducted to confirm the reliability of the findings. Results The high-dose group had significantly shorter pLOS and lower overall complication rate than the control group (10 [9–13] vs 13 [10–17] days, P = 0.010; 20.9% vs 41.9%, P = 0.011). After adjusting for multiple confounders, preoperative dexamethasone ≥10 mg was independently associated with shorter pLOS (OR 0.355, 95% CI 0.166–0.756, P = 0.007). The high-dose group showed lower risks of pulmonary infection and surgical site infection. Both dexamethasone groups had reduced incidence of acute coronary syndrome. Conclusion Preoperative dexamethasone ≥10 mg was associated with improved short-term postoperative outcomes in elderly gastric cancer patients, while the dose <10 mg only correlated with lower acute coronary syndrome risk. These observational associations need further prospective validation.