Implementation of high-dose glucocorticoids and opioid consumption in the first 24 hours after elective hip and knee arthroplasty: a natural experiment study of 47,317 procedures in Eastern Denmark
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background In Denmark, high-dose perioperative glucocorticoids were implemented stepwise for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). We aimed to estimate the opioid-sparing effect of adding a single high dose of glucocorticoids to the analgesic regimen. Methods In this prespecified analysis of a multicentre natural experiment using electronic health record data, we included all elective THA, TKA, or UKA procedures performed in Eastern Denmark from 2017-2025, with no exclusion criteria. At each centre, procedures before implementation of high-dose glucocorticoids served as controls, whereas procedures after implementation comprised the intervention group. A high dose was defined as ≥16 mg or 0.2 mg/kg dexamethasone or ≥80 mg methylprednisolone. The primary outcome was the adjusted between-group difference in 0-24h opioid consumption. The minimal important difference was 5 mg IV morphine equivalents. Secondary outcomes were maximum 0-10 numerical rating scale (NRS) pain score, incidence of opioid-related adverse events, hospital length of stay, and days alive and out of hospital at 30 days. Results We analysed 47,317 procedures performed at nine centres: 13,010 controls and 34,307 in the intervention group. During the study period, five of nine centres implemented high-dose glucocorticoids for THA patients, two of eight for TKA/UKA patients. High-dose glucocorticoids were administered to 6% and 92% of patients before and after implementation, respectively. The implementation was associated with an adjusted mean reduction of 3.8 mg IV morphine equivalents (95% CI 3.3–4.3) and a 0.8-point lower maximum recorded pain score (99% CI 0.7–0.9) in the first 24 hours, with no statistically significant differences in the remaining outcomes. Conclusions Implementation of high-dose glucocorticoids was associated with only a small drop in opioid consumption, below the minimal important difference. Key Points Summary Question : What opioid-sparing effects may be expected when adding high-dose glucocorticoids (≥16 mg or 0.2 mg/kg dexamethasone or ≥80 mg methylprednisolone) to the standard analgesic package for patients undergoing total hip and knee arthroplasty? Findings : In Eastern Denmark, the adoption of high-dose glucocorticoids to the existing multimodal analgesic regimen was associated with a slightly lower 0-to-24 hours in-hospital opioid consumption, according to electronic health record data. Meaning : Clinicians may expect a slightly lower opioid-sparing effect from high-dose glucocorticoids than found in randomised clinical trials.
Source: medRxiv
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7206184123