title: The Impact of Preoperative Dexamethasone on the Magnitude of the Postoperative Systemic Inflammatory Response and Complications Following Surgery for Colorectal Cancer.
abstract: BACKGROUND
  The magnitude of the postoperative systemic inflammatory response (SIR), as evidenced by C-reactive protein (CRP), is associated with both short- and long-term outcomes following surgery for colorectal cancer. The present study examined the impact of preoperative dexamethasone on the postoperative SIR and complications following elective surgery for colorectal cancer.
  
  
  METHODS
  Patients who underwent elective surgery, with curative intent, for colorectal cancer at a single center between 2008 and 2016 were included (n = 556) in this study. Data on the use of preoperative dexamethasone were obtained from anesthetic records, and its impact on CRP on postoperative days (PODs) 3 and 4, as well as postoperative complications, was assessed using propensity score matching (n = 276).
  
  
  RESULTS
  In the propensity score-matched cohort, preoperative dexamethasone was associated with fewer patients exceeding the established CRP threshold of 150 mg/L on POD 3 (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.26-0.70, p < 0.001) and fewer postoperative complications (OR 0.53, 95% CI 0.33-0.86, p = 0.009). Similar results for both POD 3 CRP and complications were observed when using propensity score-adjusted regression (OR 0.40, 95% CI 0.28-0.57 and OR 0.57, 95% CI 0.41-0.80, respectively) and propensity score stratification (OR 0.41, 95% CI 0.25-0.57 and OR 0.53, 95% CI 0.33-0.86, respectively).
  
  
  CONCLUSIONS
  Preoperative dexamethasone was associated with a lower postoperative SIR and fewer complications following elective surgery for colorectal cancer.
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, Scotland, UK. s.mcsorley@doctors.org.uk.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McSorley
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Campbell S D
authors.initials: CSD
authors.lastname: Roxburgh
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, Scotland, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003907:Dexamethasone / Q000627:therapeutic use*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone