Impact of perioperative dexamethasone on postoperative complications in diabetic patients undergoing spine surgery

Background: Dexamethasone is commonly used perioperatively for analgesic and antiemetic benefit, however, the risk of postoperative hyperglycemia is concerning, particularly among diabetic patients undergoing spine surgery, where extensive tissue exposure and hardware implantation may increase risk of wound complications. The influence of baseline glycemic control and surgical approach on dexamethasone-associated risk remains poorly characterized. Methods: A retrospective cohort study using the TriNetX United States Collaborative Network, a nationally representative database comprised of over 117 million unique patients, was conducted. Adults with diabetes mellitus who underwent spine surgery between 2014 and 2024 were identified and categorized into anterior cervical, posterior cervical, lumbar decompression, and lumbar decompression with fusion groups. Patients receiving perioperative dexamethasone were compared with matched controls who did not receive dexamethasone using 1:1 propensity score matching. Patients were stratified by preoperative hemoglobin A1c (