Steven B. Porter’s research while affiliated with Mayo Foundation for Medical Education and Research and other places

Background Dexamethasone (DEX) has been shown to reduce pain and postoperative nausea and vomiting for patients undergoing elective total joint arthroplasty (TJA). We investigated the impact of DEX on glycemic control and outcomes in patients with type 2 diabetes mellitus undergoing elective primary TJA. Methods All patients with type 2 diabetes mellitus undergoing primary elective TJA between January 2016 and December 2021 at 4 sites within 1 hospital system were identified. Propensity scores were calculated to match patients receiving or not receiving DEX. Primary outcomes were perioperative blood glucose levels and the incidence of hyperglycemia. Secondary outcomes were the amount of insulin administered, the occurrence of 30-day postoperative surgical site infections, hospital readmission, and mortality. Results After matching, we identified 1372 patients. DEX administration was associated with a significant increase in mean blood glucose levels in mg/dL on postoperative days (PODs) 0 to 2: POD 0 (28.4, 95% confidence interval [CI]: 24.6-32.1), POD 1 (14.4, 95% CI: 10.1-18.8), POD 2 (12.4, 95% CI: 7.5-17.2) when comparing patients who did or did not receive DEX. Additionally, patients receiving DEX, compared to patients who did not receive DEX, had increased odds of experiencing hyperglycemia on POD 0 (odds ratio: 4.0, 95% CI: 3.1-5.2). DEX was not associated with a significant difference in insulin administration, surgical site infections, hospital readmission, or mortality. Conclusions In our review of 1372 patients with propensity-matched type 2 diabetes mellitus undergoing elective, primary TJA, we found that DEX administration was associated with an increased risk of elevated mean glucose on POD 0-2, hyperglycemia on POD 0, but was not associated with an increase in total insulin dose administered nor occurrence of surgical site infections, hospital readmission, or mortality within 30 days of surgery in patients who received DEX compared to patients who did not receive DEX. Level of Evidence IV.

Objectives: To compare outcomes in males given perioperative tranexamic acid (TXA) during Holmium Laser Enucleation of the Prostate (HoLEP) to a historical cohort that did not receive TXA. Methods: Our cohort included HoLEP patients (N=1037) from August 2018 through November 2022. Exclusion criteria included history of stroke, transient ischemic attack, or coronary stent placed within 18 months. The primary predictor was TXA during HoLEP. The primary outcome variable was a return to the operating room (RTOR) for bleeding. Secondary outcomes included catheter reinsertion, transfusion, and clotting complications. Multivariable models evaluating associations of TXA with outcomes were adjusted for potential confounders. Results: In our cohort, 214/1035 had one or more complications with 81 having a Clavien-Dindo Grade of 3a or higher, 114/1037 with catheter reinsertion, 36/1037 RTOR for bleeding, and 15/1035 had a transfusion. TXA use was not associated with 30-day RTOR. 3.7% of those without TXA had a RTOR, and 3.1% of those with TXA had a RTOR (adjusted odds ratio 0.63, 95% CI 0.28-1.38, p=0.25). Transfusion rates were higher for those without TXA (2.0%) compared to with (0.5%). This was statistically significant after adjustment (adjusted odds ratio 0.13, 95% CI 0.03-0.69, p=0.016) and after correction for multiple testing (corrected p=0.048). TXA use was not associated with catheter reinsertion or clotting complications. Conclusions: Routine perioperative intravenous TXA in HoLEP patients was not associated with a reduction of RTOR for bleeding, catheter reinsertion, or clotting complications. TXA was associated with decreased transfusions with a low overall event rate of 1.4%.

This book discusses different topics in regional anesthesia and acute pain medicine (RAAPM). It is designed to be comprehensive and very practical. The book follows the format of the (problem-based learning discussion) learning style where information is presented in a very interactive way that will help retention of the information and engagement of the readers. Each chapter starts with a vignette that narrates a clinical scenario that anesthesia practitioner will encounter in their everyday RAAPM practice and concludes with a comprehensive discussion of the topic. Overall, the book is divided into sections, including basic concepts in RAAPM, pharmacology, obstetric and pediatric anesthesia, and acute pain medicine. Other sections review peripheral nerve blocks in different anatomical regions of the body to provide a comprehensive coverage of the practice of regional anesthesia. Topics discussed range from traditional to contemporary approaches in regional anesthesia techniques and some of the stables in RAAPM, such as practice guidelines. We were able to assemble a very diverse group of authors for the various chapters that provides different points of views and reflects diversity of practice across different institutions. Each chapter comes with illustrative figures and artwork, that enhances the discussion. The book concludes with a section of multiple-choice questions that are answered from the chapters.