title: Postoperative leukocyte changes in facial fracture patients: a randomized prospective study with short-term dexamethasone.
abstract: OBJECTIVE
  We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes.
  
  
  METHODS
  Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone, whereas patients in the control group received no glucocorticoid. All patients received antibiotics until postoperative days 7-10. Leukocyte count was measured on postoperative days 1 and 2. Clinical infections were observed during the follow-up.
  
  
  RESULTS
  A total of 110 adult patients were included in the study. Postoperative leukocytosis was found in 91.2% of patients receiving dexamethasone and in 67.9% of controls. Dexamethasone was associated strongly with leukocyte rise (p < 0.001) on both postoperative days. Transoral surgery and younger age (≤40 years) showed significant associations with leukocytosis on the first postoperative day (p = 0.002). In regression analyses, dexamethasone associated with leukocytosis most significantly (p < 0.001). No association was found with infections.
  
  
  CONCLUSIONS
  Dexamethasone use was the most significant predictor of leukocyte rise. As a drug response, perioperative dexamethasone caused sixfold postoperative leukocytosis. High-dose dexamethasone-induced leukocytosis may confuse the clinical decision-making especially in assessment of early infections.
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland. johanna.snall@helsinki.fi.
authors.forename: Johanna
authors.initials: J
authors.lastname: Snäll
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Törnwall
authors.affiliation: Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.|Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anna Liisa
authors.initials: AL
authors.lastname: Suominen
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, 00029, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Thorén
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000139:chemically induced* / Q000276:immunology; D008297:Male; D008446:Maxillofacial Injuries / Q000188:drug therapy* / Q000276:immunology* / Q000601:surgery; D008875:Middle Aged; D011292:Premedication; D055815:Young Adult
chemical_list: D003907:Dexamethasone
keywords: Dexamethasone; Facial fracture; Leukocytosis; Perioperative glucocorticoid