title: Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX).
abstract: BACKGROUND
  In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes.
  
  
  METHODS
  Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II.
  
  
  RESULTS
  Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes.
  
  
  CONCLUSIONS
  Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus.
  
  
  BACKGROUND
  NCT00430989.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia mascor@bigpond.net.au.|School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Western Australia Health Department, Perth, Western Australia, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Corcoran
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kasza
authors.affiliation: Department of Anaesthesia, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand.
authors.forename: T G
authors.initials: TG
authors.lastname: Short
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia.
authors.forename: E
authors.initials: E
authors.lastname: O'Loughlin
authors.affiliation: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: M T V
authors.initials: MT
authors.lastname: Chan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Anaesthesia, Perioperative and Pain Medicine Unit, and Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Leslie
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Forbes
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Paech
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.|Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Myles
mesh_terms: D000368:Aged; D003907:Dexamethasone / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D057216:Propensity Score; D012306:Risk; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: D003907:Dexamethasone
keywords: dexamethasone; nitrous oxide; postoperative nausea and vomiting; surgical wound infection