Discussion
cognitive impairment, anemia, pain, hyperglycemia, fractures, cognitive disorder, trauma
POSTOPERATIVE COMPLICATIONS, ADVERSE EVENTS, RECRUITMENT, INFECTIONS, ANEMIA, HYPERGLYCEMIA, SECONDARY, EVENTS, PATHOGENESIS
POD is a distributing problem in clinical practice, of which the pathogenesis, preventions, and treatments are still unclear [Previous studies indicated that the incidence of POD in hip fractures varied from 14.3 to 25.0% [Infections events and hyperglycemia are associated with the long-term use of high-dose steroids, but there is currently no clear evidence that a single low-dose dexamethasone given preoperatively increases these adverse events. A meta-analysis involving 51 studies confirmed that a single preoperative high-dose, short-acting corticosteroid did not increase the risk of postoperative complications after trauma surgery [The most important finding in this study is a single, preoperative, low-dose dexamethasone significantly reduced both the incidence and severity of POD in the first 5 days after surgery in geriatric ITF patients. The potential mechanism for this finding is dexamethasone reduces some POD-related inflammatory molecules like IL-1β by exerting anti-inflammatory effects [There were some differences between our study and previous similar studies [Although previous studies have reported that advanced age, gender, ASA grade, nutrition, comorbidities, preoperative cognitive disorder, preoperative anemia, pain degree, the timing of surgery, and surgery duration are the risk factors for POD [There were still several limitations in our study. First, the sample size was relatively small, and the power calculation was not precisely performed a priori, which is an inevitable drawback of this study. Although two different assessments (Nu-DESC and MDAS) and a relatively long observation duration for increasing the possibility of finding a POD were used to evaluate POD, these results should be interpreted as preliminary and hypothesis-driven for future studies. Second, the subjective bias of the investigator might be inevitable because of the single-blinded design. Third, patients with severe cognitive impairment who might have the highest risk of developing POD and suffer the greatest benefit from the intervention were not included in our study due to the protection of vulnerable groups. Fourth, anesthetic management without prespecified anesthetic protocols was left to the discretion of treating anesthesiologists, which might have a potential effect on the intervention. Fifth, prespecified stratified randomization was not performed at the recruitment, thereby further inferential conclusions about the impact of dexamethasone on subgroups could not be drawn. Finally, an increased probability of at least one false significant result might be inevitable due to the characteristic of secondary outcomes analysis. Therefore, the conclusion should necessarily be exploratory.In conclusion, a single preoperative low-dose dexamethasone may reduce both the incidence and the severity of POD in geriatric ITF patients with internal fixation surgery.