title: Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in-hospital and postdischarge recovery outcomes.
abstract: BACKGROUND
  The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy.
  
  
  METHODS
  One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed.
  
  
  RESULTS
  Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P < 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P < 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P < 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003).
  
  
  CONCLUSIONS
  Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.
authors.affiliation: Department of Anesthesiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, Illinois 60201, USA. dgmurphy2@yahoo.com
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Szokol
authors.forename: Steven B
authors.initials: SB
authors.lastname: Greenberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Vender
authors.forename: Margarita
authors.initials: M
authors.lastname: Nisman
authors.forename: Jessica
authors.initials: J
authors.lastname: Vaughn
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic; D003907:Dexamethasone / Q000627:therapeutic use*; D059026:Diagnostic Self Evaluation; D004311:Double-Blind Method; D005221:Fatigue / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D003907:Dexamethasone