Postoperative Complications Clinical Trial
Official title:
High vs Low Dose Dexamethasone on Complications in the Immediate Postoperative Phase After Nephrectomy (DEX-NEF)
The aim of this study is to investigate the effect of a single preoperative high-dose steroid
injection on complications in the immediate postoperative phase after open kidney surgery
(kidney resection, heminephrectomy, nephrectomy). Primary outcome is complications in the
post anaesthesia care unit (PACU). Secondary outcomes are organospecific complications in the
post anaesthesia phase, pain and nausea the first 5 days, seroma and wound infection the
first 14 days and readmissions the first 30 days after surgery.
The investigators hypothesize that the frequency of transfer to the PACU and organospecific
complications will be lower among patients receiving high dose dexamethasone. The
investigators hypothesize, that there will be no difference in wound infections, seroma or
readmissions.
Post-surgery, patients are traditionally observed and treated in post-anesthesia care units
(PACU) until they are discharged to the ward (or directly home) assessed by standardized
international discharge criteria.
The research project "Why in PACU?" (Rigshospitalet, Denmark), has since the beginning of
2016 systematically collected and analyzed procedure-related complications in the recovery
phase. The complications include pain, nausea/vomiting, circulatory and respiratory problems,
orthostatic intolerance and cognitive disorders. Common to all the above-mentioned
post-operative problems are the possible links to the inflammatory response caused by the
surgical trauma.
Glucocorticoids can in this context be central for the reduction of acute postoperative organ
dysfunctions, caused by the anti-inflammatory effect. In a number of different surgical
procedures, single dose, pre-operative glucocorticoids have been shown to reduce
post-operative nausea and vomiting (PONV), acute pain and need of opioids as well as
accelerate the convalescence.
Meta-analyses also showed that single-dose administration of glucocorticoids
(methylprednisolone and dexamethasone) for surgical patients is safe as opposed to long-term
treatment.
The "Why in PACU?" database shows that 60 % of patients having open kidney surgery have
complications in the PACU (primarily pain and hypoxia).
Based on positive results in other procedure-specific studies, all donor-nephrectomy patients
at Rigshospitalet, have received pre-operative high-dose steroids, in the form of 24 mg
dexamethasone injection since mid-2015. This has resulted in a reduction of pain requiring
treatment with 30 %.
Prior to creating clinical recommendations and standards, it is required that the results be
tested in a randomized, controlled, clinical trial.
The study is not placebo-controlled since the positive effects of dexamethasone 8 mg on PONV
have been shown in numerous trials, and is already being administered to all patients at the
clinic. It would therefore not be ethically correct to withdraw from this practise
;
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