The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial

The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial Xiao-yang Liu, Ping Mou, Jian Cao, Xu-ming Chen, Hao-yang Wang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4085419/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Jul, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 9 You are reading this latest preprint version Abstract Background In patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even in patients without diabetes. This study aimed to demonstrate the impact of different administration regimens of dexamethasone in postoperative BG levels. Methods In this randomized, controlled, double-blind trial, 136 patients without diabetes scheduled for TJA were randomly assigned to three groups: two perioperative saline injections (Group A, placebo); a single preoperative injection of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative injections of 10 mg dexamethasone (Group C). Primary outcomes were the postoperative fasting blood glucose (FBG) levels. Secondary outcome parameters were the postoperative postprandial blood glucose (PBG) levels. Postoperative complications within 90 days were also recorded. Risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl were investigated. Results Compared to Group A, there were transient increases in FBG and PBG on postoperative days (PODs) 0 and 1 in Groups B and C. Statistical differences in FBG and PBG among the three groups were nearly absent from POD 1 onward. Both dexamethasone regimens did not increase the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. Elevated preoperative HbA1c levels may increase the risk of postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl, respectively. Conclusion Perioperative intravenous high-dose dexamethasone to patients without diabetes has transient effects on increasing BG levels after TJA. However, no differences were found between the split-dose and single high-dose regimens. The elevated preoperative HbA1c, but not the dexamethasone regimens were the risk factor for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl. Trial registration Chinese Clinical Trail Registry, ChiCTR2300069473. Registered 17 March 2023, https://www.chictr.org.cn/showproj.html?proj=186760. total joint arthroplasty dexamethasone fasting blood glucose postprandial blood glucose Figures Figure 1 Figure 2 Figure 3 1. Background Dexamethasone has been extensively used in perioperative intravenous administration to reduce postoperative pain, opioid consumption, and the occurrence of nausea/vomiting following primary total joint arthroplasty (TJA) [ 1 – 5 ]. Recent studies further substantiated that high-dose dexamethasone yield superior efficacy than low-dose dexamethasone [ 6 , 7 ]. Additionally, compared to a preoperative single high-dose regimen, perioperative multiple doses of dexamethasone injections may further enhance the therapeutic effects [ 8 – 11 ]. Hence, orthopaedic surgeons preferred to multi-dose or high-dose dexamethasone perioperatively to enhance recovery after TJA. However, as a glucocorticoid, dexamethasone may cause immunosuppression and metabolic disorder [ 12 ]. Among the potential complications associated with dexamethasone, disturbances in glucose metabolism are significant and may lead to postoperative hyperglycemia [ 13 ]. According to previous research, postoperative fasting blood glucose (FBG) ≥ 140 mg/dl and postprandial blood glucose (PBG) ≥ 180 mg/dl may induce wound complications and periprosthetic joint infection (PJI), even in patients without diabetes [ 14 – 19 ]. Moreover, the higher the dose of dexamethasone is used, the more likely postoperative hyperglycemia is to occur. And Dhatariya et al demonstrated that patients without diabetes may exhibit heightened sensitivity to dexamethasone-induced hyperglycemia and result in more pronounced postoperative blood glucose (BG) fluctuations [ 20 ]. Therefore, studies should be conducted to discuss the impact of dexamethasone on postoperative BG in patients without diabetes undergoing TJA. There are limited studies demonstrating the impact of dexamethasone on postoperative BG in patients undergoing TJA. Nonetheless, current studies on the association of dexamethasone and BG were all retrospective and there is a lack of high-quality clinical evidence [ 21 , 22 ]. Moreover, the timing and dose of dexamethasone injections were inconsistent, which increased the confounding factors [ 23 – 25 ]. Considering the trend leans towards multi-dose or high-dose dexamethasone, the impact of these regimens on BG has not been adequately addressed [ 8 , 9 , 11 ]. Therefore, it is necessary to further clarify the effects of multiple and single high-dose dexamethasone on postoperative BG in patients without diabetes. This randomized controlled trial aimed to compare the postoperative BG levels in patients without diabetes who received different regimens of dexamethasone (0 mg, 10 + 10 mg, and 20 mg). We hypothesized that neither split-dose nor single high-dose dexamethasone would result in elevated postoperative FBG and PBG. Additionally, we explored the relationship between different doses of intravenous dexamethasone and postoperative BG. We also identified the risk factors associated with FBG ≥ 140mg/dl or PBG levels ≥ 180 mg/dl. 2. Methods 2.1. Trial design We designed a single-center, double-blind, prospective, randomized, placebo-controlled trial from May 2023 to October 2023. The trial was registered in the International Clinical Trial Registry (ChiCTR2300069473) and was approved by our institutional review board (2023 − 265) before recruitment. The report was in alignment with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines [ 26 ]. 2.2. Participants Patients aged between 18 to 80, planned for unilateral elective primary TJA for end-stage osteoarthritis were assessed for eligibility. Patients were excluded when they had (1) preoperative hyperglycemia due to diabetes mellitus or other diseases; (2) steroids use for underlying diseases; (3) been scheduled for revisions or bilateral procedures; (4) severe liver or kidney failure; (5) inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis, or systemic lupus erythematosus. Written informed consent was obtained from each patient. 2.3. Randomization and intervention The recruited patients were randomized into three groups in a 1:1:1 ratio with block sizes of six or nine using a computer-based random integer generator (Research Randomizer, www.randomizer.org ) by an external trial collaborator. The results were placed into sequentially numbered, opaque, sealed envelopes which were opened on the day of operation. The trial drug was labeled as “trial medication”, to assure blinding. In Group A, patients received two doses of intravenous normal saline, one administered before anesthesia induction, and the second given 24 hours later. Group B patients received one intravenous dose of 20 mg dexamethasone before anesthesia induction and one dose of normal saline 24 hours later. Group C patients received 10 mg dexamethasone before anesthesia induction and another 10 mg dexamethasone 24 hours later. All participants, investigators, surgeons, and statisticians were blind to the intervention. The anesthesiologists performing the interventions were not blind to the treatment, but did not participate in any outcome assessments. The nurses in charge of intravenous injections 24 hours postoperatively were also not blind, but no study group identifiers were presented to the nursing staff thereafter. 2.4. Perioperative management A standardized clinical protocol was implemented for each patient undergoing TJA [ 11 ]. All patients received intravenous tranexamic acid at a dose of 20 mg/kg 10 minutes before skin incision, and additional intravenous doses of 1 g tranexamic acid were administered 3 and 6 hours after surgery, respectively. The multimodal analgesic standard protocol was initiated upon admission, and all patients were administered diclofenac 75 mg twice daily. Before suturing the wound, all patients received local infiltration analgesia consisting of 200 mg ropivacaine (0.25%) according to a standardized regimen. The injection areas included deep tissues and superficial tissues, encompassing the superficial fascia and subcutaneous tissues. Postoperatively, patients undergoing total hip arthroplasty (THA) continued to receive diclofenac 75 mg twice daily, while patients undergoing total knee arthroplasty (TKA) were given diclofenac 75 mg twice daily and oxycodone 10 mg every 12 hours. An intramuscular injection of morphine (10 mg) was administered when visual analogue scale (VAS) pain score exceeded 5. No non-protocolized pain medication was administered. Patients received a standardized thromboembolic prophylaxis protocol, which consisted of a subcutaneous injection of 2000 IU enoxaparin at 8 hours postoperatively and then once a day (4000 IU); in addition, 10 mg rivaroxaban was prescribed for 10 days after discharge. Metoclopramide was administrated intramuscularly if the patients experienced postoperative nausea and vomiting (PONV). 2.5. Outcomes The primary outcome was the FBG and ΔFBG (FBG pod - FBG pre ) on postoperative days (POD) 0–3. Secondary outcomes were postoperative PBG and ΔPBG (PBG pod - PBG pre ) levels on PODs 1–3. The length of stay, VAS pain scores on POD 1–3 were recorded. We also identified the risk factors for FBG ≥ 140 mg/dL and PBG ≥ 180 mg/dL. FBG was measured before breakfast. On operation day, the FBG was measured two times: immediately postoperatively and immediately upon returning to the ward. PBG was measured at 2 hours after 3 meals. All BG level were measured using fingertip rapid blood glucose testing. Postoperative complications were recorded within 90-day follow-up. 2.6. Statistical analysis Based on previous studies, we estimated a mean 23 mg/dl (standard deviation, SD 27) of BG levels among groups during PODs 0 to 3 [ 27 ]. The sample size was calculated using PASS 2021 software (NCSS, LLC, Kaysville, UT) with a one-way analysis of variance designed for RCTs based on the results of previous studies. To detect a clinically meaningful effect of dexamethasone on postoperative FBG compared to placebo, a sample size of 36 participants was determined to achieve 90% power, assuming a type I error rate of 5%. Accounting for an anticipated attrition rate of 20%, we planned to recruit 135 patients. Statistical analysis was performed by entering raw data into MS Excel for computation with IBM SPSS version 24 software (IBM, Armonk, NY). Categorical data are presented as absolute and relative frequencies. Continuous data are expressed as mean (SD). One-way analysis of variance and LSD post-hoc test was performed to compare continuous variables. Chi-squared test or Fisher's Exact test was used to analyze categorical data. Given that FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl are identified as risk factors for PJI [ 14 – 19 ], we performed multivariate analysis using logistical regression with backward stepwise conditional entry of the variables ( P = 0.05 for entry; P < 0.10 for removal). The plausibly clinically relevant variables (age, gender, BMI, procedure, HbA1c, dexamethasone administration) were included. For elucidating the threshold of preoperative HbA1c level inducing hyperglycemia after TJA, a receiver operating characteristic curve with the Youden index was constructed. P < 0.05 indicated statistical significance. 3. Results 3.1. Study population Between May 3rd, 2023 and October 11th, 256 patients undergoing elective, unilateral, primary TJA for end-stage osteoarthritis were assessed for eligibility, of whom 136 were finally included in the study. Patients were randomized into the placebo group (Group A, n = 45), Group B (n = 46) and Group C (n = 45), respectively (Fig. 1 ). The baseline characteristics are presented in Table 1 . No significant differences were observed among the groups. Table 1 Baseline demographic and clinical characteristics. Characteristics Group A (DEX = 0 mg) Group B (DEX = 20 mg) Group C (DEX = 10 + 10 mg) P value Demographic characteristics Age (year old) 58.9 (9.8) 59.0 (11.1) 61.0 (12.7) 0.602 Gender (M/W) 12/33 19/27 16/29 0.335 Height (m) 1.59 (0.07) 1.61 (0.08) 1.58 (0.08) 0.264 Weight (kg) 64.1 (10.4) 66.8 (13.4) 65.9 (10.3) 0.523 BMI (kg/m 2 ) 25.0 (3.7) 25.6 (3.8) 26.2 (3.4) 0.334 Procedure (hip/knee) 21/24 23/23 22/23 0.949 Operated side (L/R) 19/26 23/23 22/23 0.725 Operation time (min) THA 81.8 (24.6) 81.2 (41.2) 90.2 (30.3) 0.600 TKA 90.0 (27.5) 92.7 (14.2) 81.3 (24.7) 0.217 ASA (I/II/III) 0/36/9 0/35/11 0/32/13 0.615 Laboratory examination HbA1c (%) 5.7 (0.4) 5.7 (0.6) 5.6 (0.4) 0.706 Preoperative FBG (mg/dL) 94.9 (12.7) 97.8 (28.2) 97.8 (12.9) 0.753 WBC Count (10 9 /L) 7.1 (1.7) 7.2 (2.0) 6.5 (2.0) 0.184 ESR (mm/h) 20.4 (15.0) 18.9 (14.8) 27.1 (20.1) 0.058 IL-6(pg/mL) 3.5 (2.8) 2.7 (1.5) 3.1 (1.6) 0.203 CRP (mg/L) 3.4 (1.6) 3.4 (2.7) 3.8 (2.6) 0.591 Hemoglobin (g/L) 125.6 (12.5) 127.3 (16.9) 128.3 (13.8) 0.666 Albumin (g/L) 43.1 (3.7) 42.9 (3.1) 43.7 (3.8) 0.552 Preoperative VAS Dynamic 4.6 (0.7) 4.7 (0.6) 4.8 (0.9) 0.220 At rest 2.5 (0.6) 2.7 (0.6) 2.6 (0.8) 0.249 Preoperative SF-12 score PCS 46.5 (3.5) 45.6 (4.0) 45.9 (3.5) 0.495 MCS 50.4 (4.5) 49.7 (4.7) 49.6 (3.5) 0.643 Preoperative WOMAC score Pain 7.4 (2.7) 6.8 (2.0) 7.1 (2.7) 0.573 Stiffness 2.9 (1.7) 3.2 (1.7) 3.3 (1.9) 0.576 Function 36.1 (5.9) 36.4 (6.1) 37.9 (6.0) 0.304 In total 46.4 (7.3) 46.4 (6.6) 48.2 (6.8) 0.323 Note: DEX, dexamethasone; M, men; W, women; BMI, body mass index; L, left; R, right; THA, total hip arthroplasty; TKA, total knee arthroplasty; ASA, American Society of Anesthesiologists; FBG, fasting blood glucose; WBC, white blood cell; ESR, erythrocyte sedimentation rate; IL-6, interleukin-6; CRP, C-reactive protein; VAS, visual analogue scale; SF-12, 12-item short form survey; PCS, Physical Component Summary; MCS, Mental Component Summary; WOMAC, the Western Ontario and McMaster Universities Osteoarthritis Index. Data are mean (standard deviation) unless stated otherwise. 3.2. Primary outcomes Compared to patients in Group A, patients in Groups B and C showed a transient increase in FBG on PODs 0 and 1 but no differences were discovered on PODs 2 and 3 among the three groups (Fig. 2 A, 2 B and Table 2 ). However, there were no differences in FBG between Groups B and C at any time interval (Table 2 ). When examining ΔFBG, Groups B and C demonstrated a similar higher change on PODs 0 and 1 compared to Group A, and there were also no differences detected between Groups B and C during hospital stay (Table 2 ). Table 2 Postoperative outcomes after TJA. Characteristics Group A (DEX = 0 mg) Group B (DEX = 20 mg) Group C (DEX = 10 + 10 mg) P value P1 (Group A VS Group B) P2 (Group A VS Group C) P3 (Group B VS Group C) FBG (mg/dl) POD 0 postop immediately 115.0 (25.6) 139.6 (26.4) 143.6 (26.3) <0.001* <0.001* <0.001* 0.486 POD 0 back to ward immediately 129.9 (31.2) 149.1 (32.0) 152.6 (21.8) <0.001* 0.002* <0.001* 0.562 POD 1 121.7 (21.6) 137.9 (22.8) 145.3 (26.2) <0.001* 0.001* <0.001* 0.136 POD 2 108.9 (17.5) 112.0 (16.9) 111.1 (16.3) 0.676 0.388 0.550 0.793 POD 3 103.6 (10.6) 103.4 (14.1) 108.1 (12.5) 0.129 0.939 0.089 0.072 △FBG (mg/dl) POD 0 postop immediately 20.7 (26.5) 41.3 (34.3) 46.1 (25.0) <0.001* 0.001* <0.001* 0.451 POD 0 back to ward immediately 35.0 (31.0) 51.3 (39.4) 54.8 (21.8) 0.008* 0.015* 0.004* 0.601 POD 1 26.8 (21.7) 40.1 (26.6) 47.5 (30.0) 0.001* 0.017* <0.001* 0.182 POD 2 14.0 (21.6) 14.2 (29.0) 13.3 (27.2) 0.983 0.970 0.891 0.861 POD 3 9.0 (13.6) 5.6 (26.4) 8.3 (21.5) 0.568 0.462 0.775 0.304 PBG (mg/dl) POD 1 Morning 143.5 (33.0) 162.2 (34.5) 170.0 (34.5) 0.002* 0.011* <0.001* 0.310 POD 1 Noon 147.9 (23.0) 165.8 (40.1) 175.2 (38.0) 0.001* 0.035* <0.001* 0.598 POD 1 night 145.8 (26.6) 169.0 (36.9) 168.3 (31.9) 0.001* 0.001* 0.001* 0.914 POD 2 Morning 141.2 (23.6) 145.9 (33.8) 148.7 (28.2) 0.481 0.453 0.231 0.649 POD 2 Noon 146.6 (20.3) 158.8 (41.2) 166.5 (35.8) 0.025* 0.230 0.006* 0.716 POD 2 night 147.1 (25.3) 151.7 (32.8) 156.8 (28.6) 0.303 0.457 0.123 0.414 POD 3 Morning 136.0 (28.5) 143.8 (35.2) 135.8 (32.8) 0.414 0.260 0.977 0.245 △PBG (mg/dl) POD 1 Morning 2.8 (32.4) 19.3 (34.2) 29.0 (35.0) 0.002* 0.023* <0.001* 0.182 POD 1 Noon 7.1 (22.8) 22.9 (39.5) 34.5 (38.2) 0.001* 0.034* <0.001* 0.115 POD 1 night 5.1 (26.7) 26.1 (36.5) 27.7 (32.0) 0.001* 0.002* 0.001* 0.822 POD 2 Morning 0.5 (23.3) 3.0 (34.1) 8.1 (27.7) 0.452 0.683 0.218 0.404 POD 2 Noon 6.1 (20.3) 15.9 (40.6) 25.9 (35.1) 0.024* 0.402 0.005* 0.510 POD 2 night 6.5 (25.7) 8.8 (32.6) 16.2 (28.8) 0.275 0.715 0.127 0.236 POD 3 Morning -4.0 (29.0) 0.7 (37.0) -4.6 (32.6) 0.710 0.505 0.936 0.452 Postoperative BG (mg/dl) Mean FBG 116.1 (15.3) 127.9 (15.6) 132.0 (12.0) <0.001* <0.001* <0.001* 0.174 Mean PBG 145.3 (18.5) 156.1 (28.4) 159.9 (21.8) 0.010* 0.029* 0.003* 0.437 Maximum BG (mg/dl) FBG (mg/dl) 141.6 (27.8) 160.6 (26.9) 166.3 (24.5) <0.001* 0.001* <0.001* 0.301 PBG (mg/dl) 173.8 (24.1) 189.1 (38.8) 201.0 (34.1) 0.001* 0.028* 140 mg/dl (%) 5/40 (11.1%) 12/34 (26.1%) 11/34 (26.7%) 0.155 0.354 0.504 1.000 PBG > 180 mg/dl (%) 3/42 (6.7%) 5/41 (10.9%) 7/38 (15.6%) 0.404 1.000 0.942 1.000 Note: TJA, total joint arthroplasty; DEX, dexamethasone; FBG, fasting blood glucose; PBG: postprandial blood glucose; BG, blood glucose; POD, postoperative day; postop: postoperative. * P < 0.05. Data are mean (standard deviation) unless stated otherwise. Additionally, patients in Groups B and C showed higher mean and maximum FBG levels than Group A within 72 hours after surgery. Nonetheless, there were no differences among the three groups when comparing the proportion of individuals with mean FBG ≥ 140 mg/dl (Table 2 ). 3.3. Secondary outcomes On POD 1, the PBG and ΔPBG levels were higher in Groups B and C than in Group A, with a similar tendency between Groups B and C (Fig. 2 C, 2 D and Table 2 ). At POD 2 noon, a statistical difference was observed between Groups A and C in PBG and ΔPBG, while no difference was found on Group A and Group B or Group B and Group C. Meanwhile, The PBG and ΔPBG were similar among the three groups thereafter. During hospital stay, Groups B and C trended towards slightly higher average and maximum PBG compared to that for Group A. Still, no differences were found in patients with postoperative PBG ≥ 180 mg/dl among the three groups (Table 2 ). 3.4. Other outcomes The dynamic pain scores on PODs 1, 2, and 3 were significantly lower for Groups B [4.80 (0.72), P < 0.001; 4.24 (0.57), P = 0.001; 3.39 (0.54), P < 0.001] and C [4.93 (0.25), P < 0.001; 3.80 (0.73), P < 0.001; 2.93 (0.65), P < 0.001] compared to Group A [5.36 (0.61); 4.73 (0.75); 3.93 (0.69)]. Such differences were also detected between Groups B and C on PODs 2 and 3 ( P = 0.003; P = 0.001, respectively). There were no differences in length of stay, postoperative complications, 90-day readmission and 90-day mortality among the three groups (Table 3 ). Table 3 Postoperative adverse events. Characteristics Group A (DEX = 0 mg) Group B (DEX = 20 mg) Group C (DEX = 10 + 10 mg) P value Length of stay 3.7 (0.9) 3.7 (0.9) 3.5 (0.7) 0.473 Wound swelling 2/45 3/46 3/45 0.882 Wound ooze 2/45 2/46 2/45 1.000 Dizziness 4/45 3/46 2/45 0.700 Gastrointestinal hemorrhage 1/45 0/46 0/45 0.361 Superficial wound infection 0/45 0/46 0/45 - Deep wound infection 0/45 0/46 0/45 - PJI 0/45 0/46 0/45 - DVT 0/45 0/46 0/45 - 90-day readmission 0/45 0/46 0/45 - 90-day mortality 0/45 0/46 0/45 - Note: DEX, dexamethasone; PJI, Prosthetic Joint Infections; DVT, Deep Venous Thrombosis. 3.5. Risk Factors for Postoperative Hyperglycemia The risk factors for FBG ≥ 140 mg/dl were identified. In the multivariate analysis, binary logistic regression was employed to determine the odds ratio (OR) of different regimens of intravenous dexamethasone and other factors for the occurrence of FBG elevation. The ORs of intravenous dexamethasone increasing the postoperative FBG level to ≥ 140mg/dl were 3.601 (0.883 to 14.692) ( P = 0.074) and 3.612 (0.943 to 13.827) ( P = 0.061), respectively (Table 4 ), indicating that compared to placebo, both dexamethasone regimens did not increase the risk of postoperative FBG level exceeding 140mg/dl. However, the elevated preoperative HbA1c levels were associated with high postoperative FBG levels (OR = 12.738 (3.648 to 44.475), P < 0.001). The threshold for preoperative HbA1c level, associated with an increased risk of FBG ≥ 140 mg/dl occurrence, was determined to be 5.65% (Fig. 3 A). The area under the curve was calculated to be 0.819. Table 4 Logistic regression of risk factors for postoperative FBG level ≥ 140 mg/dl during total hospitalization. Variable Univariate analysis Multivariate analysis VIF OR (95%CI) P value OR (95%CI) P value Age (year old) 1.020 (0.982 to 1.059) 0.312 Sex 0.773 (0.328 to 1.821) 0.556 BMI (kg/m 2 ) 1.159 (1.030 to 1.304) 0.015* 1.089 (0.952 to 1.245) 0.214 1.089 Procedure (hip/knee) 1.604 (0.687 to 3.741) 0.274 HbA1c (%) 11.727 (3.871 to 35.527) < 0.001* 12.738 (3.648 to 44.475) < 0.001* 1.131 Preoperative DEX 20 mg 2.824 (0.904 to 8.820) 0.074 3.601 (0.883 to 14.692) 0.074 1.039 10 + 10 mg 2.588 (0.818 to 8.188) 0.106 3.612 (0.943 to 13.827) 0.061 1.039 FBG, fasting blood glucose; DEX, dexamethasone; OR, odds ratio; CI, confidence interval. * P < 0.05. Similarly, we also conducted the multivariate analysis to demonstrate the risk factors for the elevation of PBG ≥ 180 mg/dl. Administering dexamethasone also did not increase the risk of the occurrence of postoperative PBG ≥ 180 mg/dl (OR = 1.535 (0.248 to 9.516), P = 0.645; OR = 4.213 (0.842 to 21.086), P = 0.080) (Table 5 ). Moreover, the elevated preoperative HbA1c levels were associated with high postoperative PBG levels (OR = 13.253 (3.612 to 48.625), P < 0.001). The threshold for preoperative HbA1c level, related with an increased risk of occurrence of PBG ≥ 180 mg/dl, was 5.75% (Fig. 3 B). The area under the curve was 0.780. Table 5 Logistic regression of risk factors for postoperative PBG level ≥ 180 mg/dl during total hospitalization. Variable Univariate analysis Multivariate analysis VIF OR (95%CI) P value OR (95%CI) P value Age (year old) 1.010 (0.963 to 1.060) 0.676 Sex 1.063 (0.341 to 3.314) 0.916 BMI (kg/m 2 ) 1.126 (0.972 to 1.303) 0.113 Procedure (hip/knee) 0.806 (0.275 to 2.361) 0.693 HbA1c (%) 7.579 (2.747 to 20.911) < 0.001* 13.253 (3.612 to 48.625) < 0.001* 1.131 Preoperative DEX 20 mg 1.707 (0.383 to 7.611) 0.483 1.535 (0.248 to 9.516) 0.645 1.039 10 + 10mg 2.579 (0.622 to 10.690) 0.192 4.213 (0.842 to 21.086) 0.080 1.039 Note: PBG, postprandial blood glucose; DEX, dexamethasone; OR, odds ratio; CI, confidence interval. * P < 0.05. 4. Discussion In this prospective, randomized, controlled and double-blind trial, we compared the postoperative glycemic control of a single high-dose of dexamethasone with a split-dose dexamethasone regimen in patients without diabetes undergoing primary elective TJA. We found that there were transient increases in FBG and PBG on PODs 0 and 1 when dexamethasone was used no matter the split-dose or single high-dose regimens. However, neither the split nor single, high-dose of dexamethasone administration increased the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. Intravenous dexamethasone has been used to mitigate not only PONV but also pain control following TJA [ 28 , 29 ]. Nevertheless, there remains concerns that the use of intravenous dexamethasone may elevate BG levels and potentially contribute to an increase in wound complications or PJI [ 25 ]. Some published literature has discussed the association between dexamethasone and BG. Allen et al documented a temporary increase in BG levels on POD 0 in 825 patients with diabetes who received 8 mg of dexamethasone [ 22 ]. Godshaw et al illustrated that the administration of dexamethasone at doses of 6 or 12 mg had no impact on postoperative BG levels in 657 patients with diabetes undergoing TJA [ 24 ]. Nurok et al demonstrated that postoperative hyperglycemia in a cohort comprising 625 patients with and without diabetes was not correlated with the administration of dexamethasone at a median dose of 4 mg [ 23 ]. Nonetheless, a systematic review indicated that the administration of intravenous dexamethasone increased BG levels within 24 hours after surgery [ 12 ]. In our study, we noted that split-dose and single high-dose dexamethasone both led to a transient elevation in FBG on PODs 0 and 1. However, no differences were detected beyond POD 1, consistent with findings from previous studies. Furthermore, our study revealed that patients administered dexamethasone experienced a greater fluctuation in FBG compared to those receiving a placebo. However, there was no significant difference observed between the split-dose and single high-dose groups, and the elevated levels swiftly returned to normal. This observation may be attributed to the heightened sensitivity of patients without diabetes to dexamethasone-induced hyperglycemia [ 20 ]. Hence, in the dexamethasone groups, the rise in BG levels was more pronounced compared to placebo, leading to a larger disparity from preoperative levels and more significant overall fluctuations. Recently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) stated that administration of multiple doses of perioperative intravenous dexamethasone results in reduced pain, decreased opioid consumption, and less nausea/vomiting compared to a single dose of perioperative intravenous dexamethasone [ 1 ]. However, whether the use of multiple doses of dexamethasone has a more substantial impact on BG remains unclear. And there lacks reports on the association of different doses of dexamethasone and postoperative hyperglycemia in patients without diabetes undergoing TJA. Arraut et al observed that in 523 patients with diabetes receiving THA and 953 patients with diabetes receiving TKA, 2 doses of 10 mg dexamethasone was associated with increased postoperative 24-hour and 60-hour BG levels compared to 1-dose cohort, nonetheless, the study was retrospective [ 21 ]. Lei et al found no differences in FBG between patients receiving a perioperative 2 doses of 10 mg dexamethasone and a preoperative 20 mg dexamethasone undergoing TJA, however, they included patients with and without diabetes, which compromised the accuracy of the conclusions [ 11 ]. Park et al investigated the effects of administering 2 doses of 5 mg dexamethasone in 427 patients without diabetes undergoing TKA and observed a transient increase in BG levels. However, this increase was not associated with levels exceeding 200 mg/dl [ 25 ]. In our study, as we mentioned before, the FBG was transient increased on PODs 0 and 1 in both split-dose and single high-dose groups. The PBG and ΔPBG levels were also higher in single high-dose group on POD 1 compared to placebo. Although differences were found between split-dose group and placebo on POD 2 noon, yet the both average PBGs were less than 180mg/dl, which did not increase the rates of wound complication and infection. Moreover, no differences were found among the three groups in the subsequent time points. Postoperative hyperglycemia is an important indicator for adverse events in surgical patients, irrespective of diabetes status [ 14 ]. Moreover, postoperative hyperglycemia may increase the risk of adverse events more significantly in patients without diabetes, further emphasizing its clinical relevance [ 15 ]. Additionally, differentiating between FBG and PBG is crucial. Given that the different indicators represented by FBG and PBG. Fasting hyperglycemia is a sign of insulin resistance, inadequate insulin production, or a combination of both [ 30 ]. Postprandial hyperglycemia, on the other hand, is indicative of insulin resistance and poor glucose tolerance [ 31 ]. Moreover, the threshold values for postoperative hyperglycemia in patients without diabetes vary between FBG and PBG, and some institutions may only monitor FBG data while others may only monitor random BG data in patients undergoing TJA. Mraovic et al conducted a perioperative hyperglycemia examination involving 1,948 patients, including 101 individuals with PJI. The study observed that patients with PJI exhibited higher FBG levels on POD 1 compared to those without PJI. Interestingly, their findings also indicated that in cases where postoperative FBG levels increased (> 140 mg/dl), patients without diabetes were three times more likely to develop infections than patients with diabetes ( P = 0.001) [ 17 ]. Kheir et al reported that the association between postoperative FBG levels on PODs 0, 1, and 2 and the occurrence of PJI exhibited a linear trend. They further identified that the optimal FBG threshold, aiming to minimize the likelihood of PJI, was determined to be 137 mg/dl [ 16 ]. In contrast, Kremers et al demonstrated that elevated random BG levels exceeding 180 mg/dL on PODs 1 to 7 were associated with an increased risk of PJI in patients undergoing TJA [ 18 ]. In a study by Kwon et al, which included 11,633 patients undergoing elective colorectal and bariatric surgery, it was observed that postoperative random BG levels surpassing 180 mg/dl on PODs 0, 1, and 2 were linked to postoperative adverse events [ 14 ]. Therefore, identifying risk factors for FBG levels ≥ 140 mg/dl and PBG levels ≥ 180 mg/dl is crucial in preventing PJI. In our study, the increase in BG induced by dexamethasone was statistically significant only on PODs 0 and 1. However, this transient elevation did not exceed the threshold associated with complications for postoperative FBG or PBG. Therefore, dexamethasone-induced BG elevation may show no clinical significance. Considering the actual analgesic and antiemetic effects of dexamethasone, we believe that its efficacy may still outweigh its adverse effects. Postoperative hyperglycemia may be the most important risk factor for surgical site infection, PJI or other complications [ 32 , 33 ]. Therefore, identifying risk factors for postoperative hyperglycemia is beneficial for early prediction of its occurrence. Godshaw et al indicated that elevated BG levels and increased rates of PJI were associated with the elevation of HbA1c rather than the use of dexamethasone [ 34 ]. Moorthy et al stated that in patients without diabetes, those who experienced postoperative hyperglycemia tended to be female, older, and obese [ 35 ]. Hence, in multivariate analysis of risk factors of postoperative hyperglycemia, we included the following indicators: dexamethasone administration, HbA1c which represents BG levels of the last 90 days, age, gender, procedure and BMI. We have reported for the first time the risk factors associated with postoperative elevation of FBG and PBG, offering a more detailed analysis compared to previous studies. Interestingly, we found that neither regimen of dexamethasone administration was a risk factor for FBG or PBG elevation, which is in alignment with previous studies. The sole risk factor for postoperative FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl was preoperative elevated HbA1c. Additionally, patients with a preoperative HbA1c level above 5.65% and 5.75% may encounter postoperative elevated FBG and PBG respectively, irrespective of dexamethasone dose and injections. This study also has several limitations. We only observed changes in BG levels until POD 3 and postoperative complications until POD 90. The long-term effects of dexamethasone on BG and its potential association with long term adverse events remain unexplored, and we will continue to follow up with our patients, aiming to report on the long-term effects of different dexamethasone regimens in future studies. Secondly, our patients may include individuals with prediabetes, and we did not differentiate this subgroup of patients. It remains unclear whether dexamethasone has different effects on BG of these patients while this lack of distinction may introduce bias into the study. Therefore, we will conduct further investigations on the effects of dexamethasone on BG in patients with prediabetes, aiming to elucidate its impact on BG in different populations. 5. Conclusions Split-dose or single high-dose of intravenous dexamethasone administration perioperatively had transient effects on increasing BG levels within POD 1 in patients without diabetes who underwent TJA. However, no differences were found between the split-dose and a single high-dose regimen. And no differences were detected on BG levels beyond POD 1. Additionally, both dexamethasone regimens did not increase the risk of FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl. The threshold for preoperative HbA1c levels associated with an increased risk of postoperative FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl was found to be 5.65% and 5.85%, respectively, regardless of the dexamethasone regimen. Abbreviations TJA: Total joint arthroplasty BG: Blood glucose FBG: Fasting blood glucose PBG: Postprandial blood glucose POD: Postoperative day PJI: Periprosthetic joint infection THA: Total hip arthroplasty TKA: Total knee arthroplasty VAS: Visual analogue scale PONV: Postoperative nausea and vomiting SD: Standard deviation OR: Odds ratio ASRA: American Society of Regional Anesthesia and Pain Medicine Pre: Preoperative Postop: Postoperative ROC: Receiver operating characteristic curve AUC: Area under the curve DEX: Dexamethasone M: men W: women; BMI: Body mass index ASA: American Society of Anesthesiologists WBC: White blood cell ESR: Erythrocyte sedimentation rate IL-6: Interleukin-6 CRP: C-reactive protein SF-12: 12-item short form survey PCS, Physical Component Summary MCS, Mental Component Summary WOMAC: The Western Ontario and McMaster Universities Osteoarthritis Index DVT: Deep Venous Thrombosis CI: confidence interval Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jian Cao, Xu-ming Chen, Hao-yang Wang, Wei-nan Zeng and Zong-ke Zhou. The first draft of the manuscript was written by Xiao-yang Liu and Ping Mou. Xiao-yang Liu and Ping Mou contributed equally to this work and should be considered as equal first authors. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Hannon CP, Fillingham YA, Mason JB, et al. Corticosteroids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty. 2022;37(9):1684–7. Dissanayake R, Du HN, Robertson LK, et al. Does Dexamethasone Reduce Hospital Readiness for Discharge, Pain, Nausea, and Early Patient Satisfaction in Hip and Knee Arthroplasty? A Randomized, Controlled Trial. J Arthroplasty. 2018;33(11):3429–36. Koh IJ, Chang CB, Lee JH, et al. Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study. Clin Orthop Relat Res. 2013;471(9):3010–20. Mathiesen O, Jacobsen LS, Holm HE, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth. 2008;101(4):535–41. Xu B, Ma J, Huang Q, et al. Two doses of low-dose perioperative dexamethasone improve the clinical outcome after total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc. 2018;26(5):1549–56. Nielsen NI, Kehlet H, Gromov K, et al. High-dose steroids in high pain responders undergoing total knee arthroplasty: a randomised double-blind trial. Br J Anaesth. 2022;128(1):150–8. Gasbjerg KS, Hagi-Pedersen D, Lunn TH et al. Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial. Bmj-British Med J. 2022;376. Xu H, Zhang S, Xie J, et al. Multiple Doses of Perioperative Dexamethasone Further Improve Clinical Outcomes After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty. 2018;33(11):3448–54. Wu Y, Lu X, Ma Y et al. Perioperative multiple low-dose Dexamethasones improves postoperative clinical outcomes after Total knee arthroplasty. BMC Musculoskelet Disord. 2018;19. Backes JR, Bentley JC, Politi JR, et al. Dexamethasone Reduces Length of Hospitalization and Improves Postoperative Pain and Nausea After Total Joint Arthroplasty A Prospective, Randomized Controlled Trial. J Arthroplasty. 2013;28(8):11–7. Lei Y, Huang Z, Huang Q, et al. Is a split-dose intravenous dexamethasone regimen superior to a single high dose in reducing pain and improving function after total hip arthroplasty? A randomized blinded placebo-controlled trial. Bone Joint J. 2020;102B(11):1497–504. Waldron NH, Jones CA, Gan TJ, et al. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013;110(2):191–200. Richardson AB, Bala A, Wellman SS, et al. Perioperative Dexamethasone Administration Does Not Increase the Incidence of Postoperative Infection in Total Hip and Knee Arthroplasty: A Retrospective Analysis. J Arthroplasty. 2016;31(8):1784–7. Kwon S, Thompson R, Dellinger P, et al. Importance of Perioperative Glycemic Control in General Surgery A Report From the Surgical Care and Outcomes Assessment Program. Ann Surg. 2013;257(1):8–14. Kotagal M, Symons RG, Hirsch IB, et al. Perioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes. Ann Surg. 2015;261(1):97–103. Kheir MM, Tan TL, Kheir M, et al. Postoperative Blood Glucose Levels Predict Infection After Total Joint Arthroplasty. J Bone Joint Surgery-American Volume. 2018;100(16):1423–31. Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol. 2011;5(2):412–8. Kremers HM, Lewallen LW, Mabry TM, et al. Diabetes Mellitus, Hyperglycemia, Hemoglobin A1C and the Risk of Prosthetic Joint Infections in Total Hip and Knee Arthroplasty. J Arthroplasty. 2015;30(3):439–43. Amer Diabet A. Standards of Medical Care in Diabetes-2010. Diabetes Care. 2010;33:S11–61. Dhatariya K. Does dexamethasone-induced hyperglycaemia contribute to postoperative morbidity and mortality? Br J Anaesth. 2013;110(5):674–5. Arraut J, Thomas J, Oakley CT et al. Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study. The Journal of arthroplasty. 2023;38(7 Suppl 2):S138-S44.e2. Allen DC, Jedrzynski NA, Michelson JD, et al. The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty. J Arthroplasty. 2020;35(3):671–4. Nurok M, Cheng J, Romeo GR, et al. Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study. J Clin Anesth. 2017;37:116–22. Godshaw BM, Mehl AE, Shaffer JG, et al. The Effects of Peri-Operative Dexamethasone on Patients Undergoing Total Hip or Knee Arthroplasty: Is It Safe for Diabetics? J Arthroplasty. 2019;34(4):645–9. Park HJ, Chang MJ, Kim TW, et al. Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty. J Arthroplasty. 2021;36(12):3909–14. Schulz K, Altman D, Moher D et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. 2010;340:c332. Varady NH, Schwab P-E, Jones T, et al. Optimal Timing of Glucose Measurements After Total Joint Arthroplasty. J Arthroplasty. 2019;34(7):S152–8. Zhou G, Ma L, Jing J et al. A meta-analysis of dexamethasone for pain management in patients with total knee arthroplasty. Medicine. 2018;97(35). De Oliveira GS Jr., Almeida MD, Benzon HT, et al. Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain A Meta- analysis of Randomized Controlled Trials. Anesthesiology. 2011;115(3):575–88. Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745–61. Nauck MA, Meier JJ. The incretin effect in healthy individuals and those with type 2 diabetes: physiology, pathophysiology, and response to therapeutic interventions. Lancet Diabetes Endocrinol. 2016;4(6):525–36. Alamanda VK, Springer BD. The prevention of infection 12 MODIFIABLE RISK FACTORS. Bone Joint J. 2019;101B(1):3–9. Ata A, Lee J, Bestle SL, et al. Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients. Arch Surg-Chicago. 2010;145(9):858–64. Godshaw BM, Ojard CA, Adams TM, et al. Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty. J Arthroplasty. 2018;33(7):S76–80. Moorthy V, Sim MA, Liu W et al. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery A prospective study. Medicine. 2019;98(23). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 Jul, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 28 May, 2024 Reviews received at journal 28 May, 2024 Reviewers agreed at journal 27 May, 2024 Reviews received at journal 19 May, 2024 Reviewers agreed at journal 14 May, 2024 Reviewers invited by journal 08 May, 2024 Editor assigned by journal 13 Mar, 2024 Submission checks completed at journal 13 Mar, 2024 First submitted to journal 12 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4085419","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":279392519,"identity":"e5cdc2fb-ce5a-4729-be5b-6c92c2fc031b","order_by":0,"name":"Xiao-yang Liu","email":"","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xiao-yang","middleName":"","lastName":"Liu","suffix":""},{"id":279392520,"identity":"3b78dc27-7c30-4c32-8b08-0cba3db41e2d","order_by":1,"name":"Ping Mou","email":"","orcid":"","institution":"Department of Rehabilitation Medicine, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Mou","suffix":""},{"id":279392521,"identity":"e4ca428d-85f7-4384-b340-794c311113f8","order_by":2,"name":"Jian Cao","email":"","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"","lastName":"Cao","suffix":""},{"id":279392522,"identity":"31841ad5-5a69-44b1-8925-039ef1fb3d3f","order_by":3,"name":"Xu-ming Chen","email":"","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xu-ming","middleName":"","lastName":"Chen","suffix":""},{"id":279392523,"identity":"0b6b51df-1d97-4a4e-b20f-6a8fd5f730f0","order_by":4,"name":"Hao-yang Wang","email":"","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hao-yang","middleName":"","lastName":"Wang","suffix":""},{"id":279392524,"identity":"76a2c885-a134-4561-8868-27fcb82023c7","order_by":5,"name":"Wei-nan Zeng","email":"","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Wei-nan","middleName":"","lastName":"Zeng","suffix":""},{"id":279392525,"identity":"dc42efee-aec9-45b6-b710-cf74fdbcc13f","order_by":6,"name":"Zong-ke Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5ElEQVRIiWNgGAWjYDACCTjNfADCOkC8FrYEkrXwGBCnRX528zHJHxV37Ga293z+8LONQY7vRgLj5wI8WhjnHEuTkDjzLHk2z9ltkr1tDMaSNxKYpWfg0cIskWMmYdh2OFlOIncbM2MbQ+KGGwlszDx4tLCBtCSCtMi/efwZqKWeoBYekJaDbYftpCV4GKSBWhIMCGmRkEhLtmw4czhBsifNTLLnnIThzDMPm6XxaZGfkXzw5o+Kw/YSxw8//vCjzEae73jywc/4tMBAYgPUViBmbCBCAwODPVGqRsEoGAWjYGQCAMdVSLG5Q8fDAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Zong-ke","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-03-12 16:15:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4085419/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4085419/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-024-04887-6","type":"published","date":"2024-07-02T15:55:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":52791254,"identity":"fd3f950f-ead0-4d2f-a14c-72f459fd3417","added_by":"auto","created_at":"2024-03-15 19:58:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":260050,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant flow diagram of the study design.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4085419/v1/debc506de5d90e8125cc1cf0.png"},{"id":52790525,"identity":"f99c9668-097a-48c7-8453-140374768e2e","added_by":"auto","created_at":"2024-03-15 19:50:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1091884,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative FBG and PBG levels are according to the administration of intravenous dexamethasone after TJA.\u003c/p\u003e\n\u003cp\u003eFBG, fasting blood glucose; TJA, total joint arthroplasty; Pre, preoperative; Postop: postoperative; POD, postoperative day; PBG, postprandial blood glucose. #\u003cem\u003eP1\u003c/em\u003e (Group A VS Group B) \u0026lt; 0.05; ##\u003cem\u003eP1\u003c/em\u003e \u0026lt; 0.01; ###\u003cem\u003e P1\u003c/em\u003e \u0026lt; 0.001; \u003cstrong\u003e*\u003c/strong\u003e\u003cem\u003eP2\u003c/em\u003e (Group A VS Group C) \u0026lt; 0.05; \u003cstrong\u003e**\u003c/strong\u003e\u003cem\u003eP2\u003c/em\u003e \u0026lt; 0.01; \u003cstrong\u003e***\u003c/strong\u003e\u003cem\u003eP2\u003c/em\u003e\u0026lt; 0.001.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4085419/v1/0e559b1ffa6ecc6579a4dc55.png"},{"id":52790523,"identity":"a60d8335-31f0-4596-b400-c1aa2d262d88","added_by":"auto","created_at":"2024-03-15 19:50:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":163356,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic curve to determine the preoperative HbA1c level threshold.\u003c/p\u003e\n\u003cp\u003eThe threshold indicates the cutoff which increases the risk for the occurrence of FBG (A) ≥ 140 mg/dl or PBG (B) ≥ 180 mg/dl in patients without diabetes after TJA. FBG, fasting blood glucose; PBG, postprandial blood glucose; TJA, total joint arthroplasty; ROC: receiver operating characteristic curve; AUC: area under the curve.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4085419/v1/39f30919eaee6653cb802da2.png"},{"id":59509020,"identity":"dddf2b4e-f3cc-463f-ac0b-784c1432a2d0","added_by":"auto","created_at":"2024-07-02 15:55:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2599906,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4085419/v1/ebc7d292-0af1-486c-abc3-506a94a095ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial","fulltext":[{"header":"1. Background","content":"\u003cp\u003eDexamethasone has been extensively used in perioperative intravenous administration to reduce postoperative pain, opioid consumption, and the occurrence of nausea/vomiting following primary total joint arthroplasty (TJA) [\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent studies further substantiated that high-dose dexamethasone yield superior efficacy than low-dose dexamethasone [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Additionally, compared to a preoperative single high-dose regimen, perioperative multiple doses of dexamethasone injections may further enhance the therapeutic effects [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Hence, orthopaedic surgeons preferred to multi-dose or high-dose dexamethasone perioperatively to enhance recovery after TJA.\u003c/p\u003e \u003cp\u003eHowever, as a glucocorticoid, dexamethasone may cause immunosuppression and metabolic disorder [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Among the potential complications associated with dexamethasone, disturbances in glucose metabolism are significant and may lead to postoperative hyperglycemia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. According to previous research, postoperative fasting blood glucose (FBG)\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and postprandial blood glucose (PBG)\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl may induce wound complications and periprosthetic joint infection (PJI), even in patients without diabetes [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Moreover, the higher the dose of dexamethasone is used, the more likely postoperative hyperglycemia is to occur. And Dhatariya et al demonstrated that patients without diabetes may exhibit heightened sensitivity to dexamethasone-induced hyperglycemia and result in more pronounced postoperative blood glucose (BG) fluctuations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, studies should be conducted to discuss the impact of dexamethasone on postoperative BG in patients without diabetes undergoing TJA. There are limited studies demonstrating the impact of dexamethasone on postoperative BG in patients undergoing TJA. Nonetheless, current studies on the association of dexamethasone and BG were all retrospective and there is a lack of high-quality clinical evidence [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, the timing and dose of dexamethasone injections were inconsistent, which increased the confounding factors [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Considering the trend leans towards multi-dose or high-dose dexamethasone, the impact of these regimens on BG has not been adequately addressed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, it is necessary to further clarify the effects of multiple and single high-dose dexamethasone on postoperative BG in patients without diabetes.\u003c/p\u003e \u003cp\u003eThis randomized controlled trial aimed to compare the postoperative BG levels in patients without diabetes who received different regimens of dexamethasone (0 mg, 10\u0026thinsp;+\u0026thinsp;10 mg, and 20 mg). We hypothesized that neither split-dose nor single high-dose dexamethasone would result in elevated postoperative FBG and PBG. Additionally, we explored the relationship between different doses of intravenous dexamethasone and postoperative BG. We also identified the risk factors associated with FBG\u0026thinsp;\u0026ge;\u0026thinsp;140mg/dl or PBG levels\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Trial design\u003c/h2\u003e \u003cp\u003eWe designed a single-center, double-blind, prospective, randomized, placebo-controlled trial from May 2023 to October 2023. The trial was registered in the International Clinical Trial Registry (ChiCTR2300069473) and was approved by our institutional review board (2023\u0026thinsp;\u0026minus;\u0026thinsp;265) before recruitment. The report was in alignment with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Participants\u003c/h2\u003e \u003cp\u003ePatients aged between 18 to 80, planned for unilateral elective primary TJA for end-stage osteoarthritis were assessed for eligibility. Patients were excluded when they had (1) preoperative hyperglycemia due to diabetes mellitus or other diseases; (2) steroids use for underlying diseases; (3) been scheduled for revisions or bilateral procedures; (4) severe liver or kidney failure; (5) inflammatory diseases including rheumatoid arthritis, ankylosing spondylitis, or systemic lupus erythematosus. Written informed consent was obtained from each patient.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Randomization and intervention\u003c/h2\u003e \u003cp\u003eThe recruited patients were randomized into three groups in a 1:1:1 ratio with block sizes of six or nine using a computer-based random integer generator (Research Randomizer, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"https://www.chictr.org.cn/showproj.html?proj=186760\" target=\"_blank\"\u003ewww.randomizer.org\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.randomizer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) by an external trial collaborator. The results were placed into sequentially numbered, opaque, sealed envelopes which were opened on the day of operation. The trial drug was labeled as \u0026ldquo;trial medication\u0026rdquo;, to assure blinding. In Group A, patients received two doses of intravenous normal saline, one administered before anesthesia induction, and the second given 24 hours later. Group B patients received one intravenous dose of 20 mg dexamethasone before anesthesia induction and one dose of normal saline 24 hours later. Group C patients received 10 mg dexamethasone before anesthesia induction and another 10 mg dexamethasone 24 hours later. All participants, investigators, surgeons, and statisticians were blind to the intervention. The anesthesiologists performing the interventions were not blind to the treatment, but did not participate in any outcome assessments. The nurses in charge of intravenous injections 24 hours postoperatively were also not blind, but no study group identifiers were presented to the nursing staff thereafter.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Perioperative management\u003c/h2\u003e \u003cp\u003eA standardized clinical protocol was implemented for each patient undergoing TJA [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. All patients received intravenous tranexamic acid at a dose of 20 mg/kg 10 minutes before skin incision, and additional intravenous doses of 1 g tranexamic acid were administered 3 and 6 hours after surgery, respectively.\u003c/p\u003e \u003cp\u003eThe multimodal analgesic standard protocol was initiated upon admission, and all patients were administered diclofenac 75 mg twice daily. Before suturing the wound, all patients received local infiltration analgesia consisting of 200 mg ropivacaine (0.25%) according to a standardized regimen. The injection areas included deep tissues and superficial tissues, encompassing the superficial fascia and subcutaneous tissues. Postoperatively, patients undergoing total hip arthroplasty (THA) continued to receive diclofenac 75 mg twice daily, while patients undergoing total knee arthroplasty (TKA) were given diclofenac 75 mg twice daily and oxycodone 10 mg every 12 hours. An intramuscular injection of morphine (10 mg) was administered when visual analogue scale (VAS) pain score exceeded 5. No non-protocolized pain medication was administered.\u003c/p\u003e \u003cp\u003ePatients received a standardized thromboembolic prophylaxis protocol, which consisted of a subcutaneous injection of 2000 IU enoxaparin at 8 hours postoperatively and then once a day (4000 IU); in addition, 10 mg rivaroxaban was prescribed for 10 days after discharge. Metoclopramide was administrated intramuscularly if the patients experienced postoperative nausea and vomiting (PONV).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome was the FBG and ΔFBG (FBG\u003csub\u003epod\u003c/sub\u003e - FBG\u003csub\u003epre\u003c/sub\u003e) on postoperative days (POD) 0\u0026ndash;3. Secondary outcomes were postoperative PBG and ΔPBG (PBG\u003csub\u003epod\u003c/sub\u003e - PBG\u003csub\u003epre\u003c/sub\u003e) levels on PODs 1\u0026ndash;3. The length of stay, VAS pain scores on POD 1\u0026ndash;3 were recorded. We also identified the risk factors for FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dL and PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dL. FBG was measured before breakfast. On operation day, the FBG was measured two times: immediately postoperatively and immediately upon returning to the ward. PBG was measured at 2 hours after 3 meals. All BG level were measured using fingertip rapid blood glucose testing. Postoperative complications were recorded within 90-day follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Statistical analysis\u003c/h2\u003e \u003cp\u003eBased on previous studies, we estimated a mean 23 mg/dl (standard deviation, SD 27) of BG levels among groups during PODs 0 to 3 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The sample size was calculated using PASS 2021 software (NCSS, LLC, Kaysville, UT) with a one-way analysis of variance designed for RCTs based on the results of previous studies. To detect a clinically meaningful effect of dexamethasone on postoperative FBG compared to placebo, a sample size of 36 participants was determined to achieve 90% power, assuming a type I error rate of 5%. Accounting for an anticipated attrition rate of 20%, we planned to recruit 135 patients.\u003c/p\u003e \u003cp\u003eStatistical analysis was performed by entering raw data into MS Excel for computation with IBM SPSS version 24 software (IBM, Armonk, NY). Categorical data are presented as absolute and relative frequencies. Continuous data are expressed as mean (SD). One-way analysis of variance and LSD post-hoc test was performed to compare continuous variables. Chi-squared test or Fisher's Exact test was used to analyze categorical data. Given that FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl are identified as risk factors for PJI [\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], we performed multivariate analysis using logistical regression with backward stepwise conditional entry of the variables (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05 for entry; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.10 for removal). The plausibly clinically relevant variables (age, gender, BMI, procedure, HbA1c, dexamethasone administration) were included. For elucidating the threshold of preoperative HbA1c level inducing hyperglycemia after TJA, a receiver operating characteristic curve with the Youden index was constructed. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Study population\u003c/h2\u003e \u003cp\u003eBetween May 3rd, 2023 and October 11th, 256 patients undergoing elective, unilateral, primary TJA for end-stage osteoarthritis were assessed for eligibility, of whom 136 were finally included in the study. Patients were randomized into the placebo group (Group A, n\u0026thinsp;=\u0026thinsp;45), Group B (n\u0026thinsp;=\u0026thinsp;46) and Group C (n\u0026thinsp;=\u0026thinsp;45), respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The baseline characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No significant differences were observed among the groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic and clinical characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (DEX\u0026thinsp;=\u0026thinsp;0 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (DEX\u0026thinsp;=\u0026thinsp;20 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C (DEX\u0026thinsp;=\u0026thinsp;10\u0026thinsp;+\u0026thinsp;10 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year old)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.9 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.0 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.0 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (M/W)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19/27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16/29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight (m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59 (0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.58 (0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.1 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.8 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.9 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.0 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.6 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.2 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure (hip/knee)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21/24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperated side (L/R)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19/26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22/23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.8 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.2 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.2 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.0 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.7 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.3 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA (I/II/III)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/36/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/35/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/32/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory examination\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.7 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.706\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative FBG (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94.9 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.8 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.8 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC Count (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR (mm/h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.4 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.9 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIL-6(pg/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.4 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125.6 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127.3 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128.3 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.1 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.7 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative VAS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDynamic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.6 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative SF-12 score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.5 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.6 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.9 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.4 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.7 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.6 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative WOMAC score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStiffness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.576\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.1 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.4 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.9 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.4 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.4 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.2 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: DEX, dexamethasone; M, men; W, women; BMI, body mass index; L, left; R, right; THA, total hip arthroplasty; TKA, total knee arthroplasty; ASA, American Society of Anesthesiologists; FBG, fasting blood glucose; WBC, white blood cell; ESR, erythrocyte sedimentation rate; IL-6, interleukin-6; CRP, C-reactive protein; VAS, visual analogue scale; SF-12, 12-item short form survey; PCS, Physical Component Summary; MCS, Mental Component Summary; WOMAC, the Western Ontario and McMaster Universities Osteoarthritis Index. Data are mean (standard deviation) unless stated otherwise.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Primary outcomes\u003c/h2\u003e \u003cp\u003eCompared to patients in Group A, patients in Groups B and C showed a transient increase in FBG on PODs 0 and 1 but no differences were discovered on PODs 2 and 3 among the three groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, there were no differences in FBG between Groups B and C at any time interval (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). When examining ΔFBG, Groups B and C demonstrated a similar higher change on PODs 0 and 1 compared to Group A, and there were also no differences detected between Groups B and C during hospital stay (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative outcomes after TJA.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (DEX\u0026thinsp;=\u0026thinsp;0 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (DEX\u0026thinsp;=\u0026thinsp;20 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C (DEX\u0026thinsp;=\u0026thinsp;10\u0026thinsp;+\u0026thinsp;10 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP1\u003c/em\u003e (Group A VS Group B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP2\u003c/em\u003e (Group A VS Group C)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP3\u003c/em\u003e (Group B VS Group C)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG (mg/dl)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 0 postop immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115.0 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139.6 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143.6 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 0 back to ward immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129.9 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149.1 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e152.6 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121.7 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137.9 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e145.3 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108.9 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112.0 (16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e111.1 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103.6 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103.4 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e108.1 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e△FBG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 0 postop immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.7 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.3 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.1 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 0 back to ward immediately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.0 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.3 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.8 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.015*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.8 (21.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.1 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.5 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.017*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.0 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.2 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.3 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.861\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.0 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6 (26.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.3 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePBG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143.5 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162.2 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e170.0 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 Noon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147.9 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e165.8 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e175.2 (38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.035*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145.8 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169.0 (36.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e168.3 (31.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141.2 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145.9 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148.7 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 Noon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146.6 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158.8 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166.5 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.025*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.006*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147.1 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151.7 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e156.8 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 3 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136.0 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143.8 (35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e135.8 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e△PBG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.8 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.3 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.0 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.023*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 Noon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.1 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.9 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.5 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.034*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 1 night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.1 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.1 (36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.7 (32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.1 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 Noon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.1 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.9 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.9 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 2 night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.5 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.8 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.2 (28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOD 3 Morning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-4.0 (29.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.6 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative BG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean FBG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116.1 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127.9 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e132.0 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean PBG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145.3 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156.1 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e159.9 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.029*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaximum BG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141.6 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160.6 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166.3 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePBG (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173.8 (24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e189.1 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e201.0 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative Hyperglycemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG\u0026thinsp;\u0026gt;\u0026thinsp;140 mg/dl (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5/40 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12/34 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11/34 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePBG\u0026thinsp;\u0026gt;\u0026thinsp;180 mg/dl (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3/42 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5/41 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7/38 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: TJA, total joint arthroplasty; DEX, dexamethasone; FBG, fasting blood glucose; PBG: postprandial blood glucose; BG, blood glucose; POD, postoperative day; postop: postoperative. \u003cb\u003e*\u003c/b\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Data are mean (standard deviation) unless stated otherwise.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, patients in Groups B and C showed higher mean and maximum FBG levels than Group A within 72 hours after surgery. Nonetheless, there were no differences among the three groups when comparing the proportion of individuals with mean FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Secondary outcomes\u003c/h2\u003e \u003cp\u003eOn POD 1, the PBG and ΔPBG levels were higher in Groups B and C than in Group A, with a similar tendency between Groups B and C (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). At POD 2 noon, a statistical difference was observed between Groups A and C in PBG and ΔPBG, while no difference was found on Group A and Group B or Group B and Group C. Meanwhile, The PBG and ΔPBG were similar among the three groups thereafter.\u003c/p\u003e \u003cp\u003eDuring hospital stay, Groups B and C trended towards slightly higher average and maximum PBG compared to that for Group A. Still, no differences were found in patients with postoperative PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl among the three groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Other outcomes\u003c/h2\u003e \u003cp\u003eThe dynamic pain scores on PODs 1, 2, and 3 were significantly lower for Groups B [4.80 (0.72), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 4.24 (0.57), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; 3.39 (0.54), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and C [4.93 (0.25), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 3.80 (0.73), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 2.93 (0.65), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] compared to Group A [5.36 (0.61); 4.73 (0.75); 3.93 (0.69)]. Such differences were also detected between Groups B and C on PODs 2 and 3 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001, respectively). There were no differences in length of stay, postoperative complications, 90-day readmission and 90-day mortality among the three groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative adverse events.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (DEX\u0026thinsp;=\u0026thinsp;0 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (DEX\u0026thinsp;=\u0026thinsp;20 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C (DEX\u0026thinsp;=\u0026thinsp;10\u0026thinsp;+\u0026thinsp;10 mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound swelling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound ooze\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastrointestinal hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperficial wound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep wound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePJI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: DEX, dexamethasone; PJI, Prosthetic Joint Infections; DVT, Deep Venous Thrombosis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5. Risk Factors for Postoperative Hyperglycemia\u003c/h2\u003e \u003cp\u003eThe risk factors for FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl were identified. In the multivariate analysis, binary logistic regression was employed to determine the odds ratio (OR) of different regimens of intravenous dexamethasone and other factors for the occurrence of FBG elevation. The ORs of intravenous dexamethasone increasing the postoperative FBG level to \u0026ge;\u0026thinsp;140mg/dl were 3.601 (0.883 to 14.692) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.074) and 3.612 (0.943 to 13.827) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.061), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), indicating that compared to placebo, both dexamethasone regimens did not increase the risk of postoperative FBG level exceeding 140mg/dl. However, the elevated preoperative HbA1c levels were associated with high postoperative FBG levels (OR\u0026thinsp;=\u0026thinsp;12.738 (3.648 to 44.475), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The threshold for preoperative HbA1c level, associated with an increased risk of FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl occurrence, was determined to be 5.65% (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). The area under the curve was calculated to be 0.819.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression of risk factors for postoperative FBG level\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl during total hospitalization.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year old)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.020 (0.982 to 1.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.773 (0.328 to 1.821)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.159 (1.030 to 1.304)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.015*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.089 (0.952 to 1.245)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProcedure (hip/knee)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.604 (0.687 to 3.741)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHbA1c (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.727 (3.871 to 35.527)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.738 (3.648 to 44.475)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative DEX\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20 mg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.824 (0.904 to 8.820)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.601 (0.883 to 14.692)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u0026thinsp;+\u0026thinsp;10 mg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.588 (0.818 to 8.188)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.612 (0.943 to 13.827)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eFBG, fasting blood glucose; DEX, dexamethasone; OR, odds ratio; CI, confidence interval. \u003cb\u003e*\u003c/b\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSimilarly, we also conducted the multivariate analysis to demonstrate the risk factors for the elevation of PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl. Administering dexamethasone also did not increase the risk of the occurrence of postoperative PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl (OR\u0026thinsp;=\u0026thinsp;1.535 (0.248 to 9.516), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.645; OR\u0026thinsp;=\u0026thinsp;4.213 (0.842 to 21.086), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.080) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Moreover, the elevated preoperative HbA1c levels were associated with high postoperative PBG levels (OR\u0026thinsp;=\u0026thinsp;13.253 (3.612 to 48.625), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The threshold for preoperative HbA1c level, related with an increased risk of occurrence of PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl, was 5.75% (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). The area under the curve was 0.780.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression of risk factors for postoperative PBG level\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl during total hospitalization.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVIF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year old)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.010 (0.963 to 1.060)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.063 (0.341 to 3.314)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.126 (0.972 to 1.303)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProcedure (hip/knee)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.806 (0.275 to 2.361)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHbA1c (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.579 (2.747 to 20.911)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.253 (3.612 to 48.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative DEX\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e20 mg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.707 (0.383 to 7.611)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.535 (0.248 to 9.516)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e10\u0026thinsp;+\u0026thinsp;10mg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.579 (0.622 to 10.690)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.213 (0.842 to 21.086)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: PBG, postprandial blood glucose; DEX, dexamethasone; OR, odds ratio; CI, confidence interval. \u003cb\u003e*\u003c/b\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this prospective, randomized, controlled and double-blind trial, we compared the postoperative glycemic control of a single high-dose of dexamethasone with a split-dose dexamethasone regimen in patients without diabetes undergoing primary elective TJA. We found that there were transient increases in FBG and PBG on PODs 0 and 1 when dexamethasone was used no matter the split-dose or single high-dose regimens. However, neither the split nor single, high-dose of dexamethasone administration increased the risk for postoperative FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl or PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl.\u003c/p\u003e \u003cp\u003eIntravenous dexamethasone has been used to mitigate not only PONV but also pain control following TJA [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Nevertheless, there remains concerns that the use of intravenous dexamethasone may elevate BG levels and potentially contribute to an increase in wound complications or PJI [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Some published literature has discussed the association between dexamethasone and BG. Allen et al documented a temporary increase in BG levels on POD 0 in 825 patients with diabetes who received 8 mg of dexamethasone [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Godshaw et al illustrated that the administration of dexamethasone at doses of 6 or 12 mg had no impact on postoperative BG levels in 657 patients with diabetes undergoing TJA [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Nurok et al demonstrated that postoperative hyperglycemia in a cohort comprising 625 patients with and without diabetes was not correlated with the administration of dexamethasone at a median dose of 4 mg [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Nonetheless, a systematic review indicated that the administration of intravenous dexamethasone increased BG levels within 24 hours after surgery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In our study, we noted that split-dose and single high-dose dexamethasone both led to a transient elevation in FBG on PODs 0 and 1. However, no differences were detected beyond POD 1, consistent with findings from previous studies. Furthermore, our study revealed that patients administered dexamethasone experienced a greater fluctuation in FBG compared to those receiving a placebo. However, there was no significant difference observed between the split-dose and single high-dose groups, and the elevated levels swiftly returned to normal. This observation may be attributed to the heightened sensitivity of patients without diabetes to dexamethasone-induced hyperglycemia [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Hence, in the dexamethasone groups, the rise in BG levels was more pronounced compared to placebo, leading to a larger disparity from preoperative levels and more significant overall fluctuations.\u003c/p\u003e \u003cp\u003eRecently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) stated that administration of multiple doses of perioperative intravenous dexamethasone results in reduced pain, decreased opioid consumption, and less nausea/vomiting compared to a single dose of perioperative intravenous dexamethasone [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, whether the use of multiple doses of dexamethasone has a more substantial impact on BG remains unclear. And there lacks reports on the association of different doses of dexamethasone and postoperative hyperglycemia in patients without diabetes undergoing TJA. Arraut et al observed that in 523 patients with diabetes receiving THA and 953 patients with diabetes receiving TKA, 2 doses of 10 mg dexamethasone was associated with increased postoperative 24-hour and 60-hour BG levels compared to 1-dose cohort, nonetheless, the study was retrospective [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Lei et al found no differences in FBG between patients receiving a perioperative 2 doses of 10 mg dexamethasone and a preoperative 20 mg dexamethasone undergoing TJA, however, they included patients with and without diabetes, which compromised the accuracy of the conclusions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Park et al investigated the effects of administering 2 doses of 5 mg dexamethasone in 427 patients without diabetes undergoing TKA and observed a transient increase in BG levels. However, this increase was not associated with levels exceeding 200 mg/dl [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, as we mentioned before, the FBG was transient increased on PODs 0 and 1 in both split-dose and single high-dose groups. The PBG and ΔPBG levels were also higher in single high-dose group on POD 1 compared to placebo. Although differences were found between split-dose group and placebo on POD 2 noon, yet the both average PBGs were less than 180mg/dl, which did not increase the rates of wound complication and infection. Moreover, no differences were found among the three groups in the subsequent time points.\u003c/p\u003e \u003cp\u003ePostoperative hyperglycemia is an important indicator for adverse events in surgical patients, irrespective of diabetes status [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, postoperative hyperglycemia may increase the risk of adverse events more significantly in patients without diabetes, further emphasizing its clinical relevance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, differentiating between FBG and PBG is crucial. Given that the different indicators represented by FBG and PBG. Fasting hyperglycemia is a sign of insulin resistance, inadequate insulin production, or a combination of both [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Postprandial hyperglycemia, on the other hand, is indicative of insulin resistance and poor glucose tolerance [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, the threshold values for postoperative hyperglycemia in patients without diabetes vary between FBG and PBG, and some institutions may only monitor FBG data while others may only monitor random BG data in patients undergoing TJA. Mraovic et al conducted a perioperative hyperglycemia examination involving 1,948 patients, including 101 individuals with PJI. The study observed that patients with PJI exhibited higher FBG levels on POD 1 compared to those without PJI. Interestingly, their findings also indicated that in cases where postoperative FBG levels increased (\u0026gt;\u0026thinsp;140 mg/dl), patients without diabetes were three times more likely to develop infections than patients with diabetes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Kheir et al reported that the association between postoperative FBG levels on PODs 0, 1, and 2 and the occurrence of PJI exhibited a linear trend. They further identified that the optimal FBG threshold, aiming to minimize the likelihood of PJI, was determined to be 137 mg/dl [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In contrast, Kremers et al demonstrated that elevated random BG levels exceeding 180 mg/dL on PODs 1 to 7 were associated with an increased risk of PJI in patients undergoing TJA [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In a study by Kwon et al, which included 11,633 patients undergoing elective colorectal and bariatric surgery, it was observed that postoperative random BG levels surpassing 180 mg/dl on PODs 0, 1, and 2 were linked to postoperative adverse events [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, identifying risk factors for FBG levels\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and PBG levels\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl is crucial in preventing PJI. In our study, the increase in BG induced by dexamethasone was statistically significant only on PODs 0 and 1. However, this transient elevation did not exceed the threshold associated with complications for postoperative FBG or PBG. Therefore, dexamethasone-induced BG elevation may show no clinical significance. Considering the actual analgesic and antiemetic effects of dexamethasone, we believe that its efficacy may still outweigh its adverse effects.\u003c/p\u003e \u003cp\u003ePostoperative hyperglycemia may be the most important risk factor for surgical site infection, PJI or other complications [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, identifying risk factors for postoperative hyperglycemia is beneficial for early prediction of its occurrence. Godshaw et al indicated that elevated BG levels and increased rates of PJI were associated with the elevation of HbA1c rather than the use of dexamethasone [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Moorthy et al stated that in patients without diabetes, those who experienced postoperative hyperglycemia tended to be female, older, and obese [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Hence, in multivariate analysis of risk factors of postoperative hyperglycemia, we included the following indicators: dexamethasone administration, HbA1c which represents BG levels of the last 90 days, age, gender, procedure and BMI. We have reported for the first time the risk factors associated with postoperative elevation of FBG and PBG, offering a more detailed analysis compared to previous studies. Interestingly, we found that neither regimen of dexamethasone administration was a risk factor for FBG or PBG elevation, which is in alignment with previous studies. The sole risk factor for postoperative FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl was preoperative elevated HbA1c. Additionally, patients with a preoperative HbA1c level above 5.65% and 5.75% may encounter postoperative elevated FBG and PBG respectively, irrespective of dexamethasone dose and injections.\u003c/p\u003e \u003cp\u003eThis study also has several limitations. We only observed changes in BG levels until POD 3 and postoperative complications until POD 90. The long-term effects of dexamethasone on BG and its potential association with long term adverse events remain unexplored, and we will continue to follow up with our patients, aiming to report on the long-term effects of different dexamethasone regimens in future studies. Secondly, our patients may include individuals with prediabetes, and we did not differentiate this subgroup of patients. It remains unclear whether dexamethasone has different effects on BG of these patients while this lack of distinction may introduce bias into the study. Therefore, we will conduct further investigations on the effects of dexamethasone on BG in patients with prediabetes, aiming to elucidate its impact on BG in different populations.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eSplit-dose or single high-dose of intravenous dexamethasone administration perioperatively had transient effects on increasing BG levels within POD 1 in patients without diabetes who underwent TJA. However, no differences were found between the split-dose and a single high-dose regimen. And no differences were detected on BG levels beyond POD 1. Additionally, both dexamethasone regimens did not increase the risk of FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl. The threshold for preoperative HbA1c levels associated with an increased risk of postoperative FBG\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dl and PBG\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dl was found to be 5.65% and 5.85%, respectively, regardless of the dexamethasone regimen.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTJA: Total joint arthroplasty\u003c/p\u003e\n\u003cp\u003eBG: Blood glucose\u003c/p\u003e\n\u003cp\u003eFBG: Fasting blood glucose\u003c/p\u003e\n\u003cp\u003ePBG: Postprandial blood glucose\u003c/p\u003e\n\u003cp\u003ePOD: Postoperative day\u003c/p\u003e\n\u003cp\u003ePJI: Periprosthetic joint infection\u003c/p\u003e\n\u003cp\u003eTHA: Total hip arthroplasty\u003c/p\u003e\n\u003cp\u003eTKA: Total knee arthroplasty\u003c/p\u003e\n\u003cp\u003eVAS: Visual analogue scale\u003c/p\u003e\n\u003cp\u003ePONV:\u0026nbsp;Postoperative nausea and vomiting\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation\u003c/p\u003e\n\u003cp\u003eOR: Odds ratio\u003c/p\u003e\n\u003cp\u003eASRA: American Society of Regional Anesthesia and Pain Medicine\u003c/p\u003e\n\u003cp\u003ePre: Preoperative\u003c/p\u003e\n\u003cp\u003ePostop: Postoperative\u003c/p\u003e\n\u003cp\u003eROC: Receiver operating characteristic curve\u003c/p\u003e\n\u003cp\u003eAUC: Area under the curve\u003c/p\u003e\n\u003cp\u003eDEX: Dexamethasone\u003c/p\u003e\n\u003cp\u003eM: men\u003c/p\u003e\n\u003cp\u003eW: women;\u003c/p\u003e\n\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003eASA: American Society of Anesthesiologists\u003c/p\u003e\n\u003cp\u003eWBC: White blood cell\u003c/p\u003e\n\u003cp\u003eESR: Erythrocyte sedimentation rate\u003c/p\u003e\n\u003cp\u003eIL-6: Interleukin-6\u003c/p\u003e\n\u003cp\u003eCRP: C-reactive protein\u003c/p\u003e\n\u003cp\u003eSF-12: 12-item short form survey\u003c/p\u003e\n\u003cp\u003ePCS, Physical Component Summary\u003c/p\u003e\n\u003cp\u003eMCS, Mental Component Summary\u003c/p\u003e\n\u003cp\u003eWOMAC: The Western Ontario and McMaster Universities Osteoarthritis Index\u003c/p\u003e\n\u003cp\u003eDVT: Deep Venous Thrombosis\u003c/p\u003e\n\u003cp\u003eCI: confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jian Cao, Xu-ming Chen, Hao-yang Wang, Wei-nan Zeng and Zong-ke Zhou. The first draft of the manuscript was written by Xiao-yang Liu and Ping Mou. Xiao-yang Liu and Ping Mou contributed equally to this work and should be considered as equal first authors. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHannon CP, Fillingham YA, Mason JB, et al. Corticosteroids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society. J Arthroplasty. 2022;37(9):1684\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDissanayake R, Du HN, Robertson LK, et al. 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Standards of Medical Care in Diabetes-2010. Diabetes Care. 2010;33:S11\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhatariya K. Does dexamethasone-induced hyperglycaemia contribute to postoperative morbidity and mortality? Br J Anaesth. 2013;110(5):674\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArraut J, Thomas J, Oakley CT et al. Effects of Dexamethasone on Postoperative Glycemic Control in Diabetic Patients Following Primary Total Joint Arthroplasty: A Retrospective Cohort Study. The Journal of arthroplasty. 2023;38(7 Suppl 2):S138-S44.e2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen DC, Jedrzynski NA, Michelson JD, et al. The Effect of Dexamethasone on Postoperative Blood Glucose in Patients With Type 2 Diabetes Mellitus Undergoing Total Joint Arthroplasty. J Arthroplasty. 2020;35(3):671\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNurok M, Cheng J, Romeo GR, et al. Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study. J Clin Anesth. 2017;37:116\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodshaw BM, Mehl AE, Shaffer JG, et al. The Effects of Peri-Operative Dexamethasone on Patients Undergoing Total Hip or Knee Arthroplasty: Is It Safe for Diabetics? J Arthroplasty. 2019;34(4):645\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark HJ, Chang MJ, Kim TW, et al. Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty. J Arthroplasty. 2021;36(12):3909\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchulz K, Altman D, Moher D et al. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. 2010;340:c332.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVarady NH, Schwab P-E, Jones T, et al. Optimal Timing of Glucose Measurements After Total Joint Arthroplasty. J Arthroplasty. 2019;34(7):S152\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou G, Ma L, Jing J et al. A meta-analysis of dexamethasone for pain management in patients with total knee arthroplasty. Medicine. 2018;97(35).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Oliveira GS Jr., Almeida MD, Benzon HT, et al. Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain\u0026thinsp;\u0026lt;\u0026thinsp;i\u0026thinsp;\u0026gt;\u0026thinsp;A Meta-\u0026lt;i\u0026thinsp;\u0026gt;\u0026thinsp;analysis of Randomized Controlled Trials\u0026lt;/i\u0026thinsp;\u0026gt;. Anesthesiology. 2011;115(3):575\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeimann A, Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNauck MA, Meier JJ. The incretin effect in healthy individuals and those with type 2 diabetes: physiology, pathophysiology, and response to therapeutic interventions. Lancet Diabetes Endocrinol. 2016;4(6):525\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlamanda VK, Springer BD. The prevention of infection 12 MODIFIABLE RISK FACTORS. Bone Joint J. 2019;101B(1):3\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAta A, Lee J, Bestle SL, et al. Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients. Arch Surg-Chicago. 2010;145(9):858\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodshaw BM, Ojard CA, Adams TM, et al. Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty. J Arthroplasty. 2018;33(7):S76\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoorthy V, Sim MA, Liu W et al. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery A prospective study. Medicine. 2019;98(23).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"total joint arthroplasty, dexamethasone, fasting blood glucose, postprandial blood glucose","lastPublishedDoi":"10.21203/rs.3.rs-4085419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4085419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn patients undergoing total joint arthroplasty (TJA), the administration of dexamethasone may contribute to perioperative blood glucose (BG) disturbances, potentially resulting in complications, even in patients without diabetes. This study aimed to demonstrate the impact of different administration regimens of dexamethasone in postoperative BG levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this randomized, controlled, double-blind trial, 136 patients without diabetes scheduled for TJA were randomly assigned to three groups: two perioperative saline injections (Group A, placebo); a single preoperative injection of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative injections of 10 mg dexamethasone (Group C). Primary outcomes were the postoperative fasting blood glucose (FBG) levels. Secondary outcome parameters were the postoperative postprandial blood glucose (PBG) levels. Postoperative complications within 90 days were also recorded. Risk factors for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl were investigated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared to Group A, there were transient increases in FBG and PBG on postoperative days (PODs) 0 and 1 in Groups B and C. Statistical differences in FBG and PBG among the three groups were nearly absent from POD 1 onward. Both dexamethasone regimens did not increase the risk for postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl. Elevated preoperative HbA1c levels may increase the risk of postoperative FBG ≥ 140 mg/dl or PBG ≥ 180 mg/dl, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerioperative intravenous high-dose dexamethasone to patients without diabetes has transient effects on increasing BG levels after TJA. However, no differences were found between the split-dose and single high-dose regimens. The elevated preoperative HbA1c, but not the dexamethasone regimens were the risk factor for FBG ≥ 140 mg/dl and PBG ≥ 180 mg/dl.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChinese Clinical Trail Registry, ChiCTR2300069473. Registered 17 March 2023, https://www.chictr.org.cn/showproj.html?proj=186760.\u003c/p\u003e","manuscriptTitle":"The effect of a split-dose intravenous dexamethasone and a single high-dose on postoperative blood glucose after total joint arthroplasty： A randomized double-blind placebo-controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-15 19:50:19","doi":"10.21203/rs.3.rs-4085419/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-28T13:43:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-28T13:04:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222388677814833259167854362547487742038","date":"2024-05-28T02:36:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-19T12:27:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120197859354236262416963248964411576617","date":"2024-05-14T14:44:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-08T08:13:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-14T02:10:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-14T00:34:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-03-12T13:37:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e194e5d-31d2-4337-97fd-30aa2b287654","owner":[],"postedDate":"March 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-07-02T15:55:06+00:00","versionOfRecord":{"articleIdentity":"rs-4085419","link":"https://doi.org/10.1186/s13018-024-04887-6","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2024-07-02 15:55:06","publishedOnDateReadable":"July 2nd, 2024"},"versionCreatedAt":"2024-03-15 19:50:19","video":"","vorDoi":"10.1186/s13018-024-04887-6","vorDoiUrl":"https://doi.org/10.1186/s13018-024-04887-6","workflowStages":[]},"version":"v1","identity":"rs-4085419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4085419","identity":"rs-4085419","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}