A Reduced Exogenous Steroid Taper for Postoperative Brain Tumor Patients—A Case-Control Study

• Published in: World neurosurgery 2019-05, Vol.125, p.e44-e47
• Main Authors: Breshears, Jonathan D., Haddad, Alexander F., Viner, Jennifer, Rau, Johnny, Sankaran, Sujatha, McDermott, Michael W.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Aged; Brain Edema - drug therapy; Brain Edema - etiology; Brain Neoplasms - surgery; Brain tumor; Case-Control Studies; Dexamethasone; Dexamethasone - administration & dosage; Diabetes Complications - complications; Drug Administration Schedule; Female; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Patient Readmission - statistics & numerical data; Postoperative cerebral edema; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Retrospective Studies; Sleep Initiation and Maintenance Disorders - etiology; Steroid taper; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.12.173

Dexamethasone is a standard treatment for cerebral edema after brain tumor surgery. However, its side effects can negatively impact the quality and safety of care provided to patients. Sparse evidence exists in the literature regarding postoperative steroid dosing to guide clinicians. The objective of this study was to determine if a new reduced exogenous steroid taper (REST) protocol would effectively treat postoperative cerebral edema while reducing the incidence of steroid-related side effects including diabetes, hypertension, and insomnia. A REST protocol (dexamethasone 38.5 mg tapered over 10 days) was instituted for patients with postoperative brain tumor of a single surgeon. Historical controls treated with a high-dose taper (dexamethasone 117 mg taper over 17 days) were selected to match for baseline characteristics. Outcomes of new or worsened diabetes, hypertension, and insomnia, as well as length of stay (LOS) and 30-day readmission rates, were compared. Twenty-five patients were included in each group. There were no significant differences in baseline characteristics. The REST group received a median of 34.5 mg (interquartile range, 32–41 mg) of dexamethasone, whereas controls received 43 mg (interquartile range, 16–91 mg) (P = 0.04). There was a significant reduction in the incidence of new or worsened hypertension in the REST group (0%) compared with controls (20%, P = 0.02). No difference was seen in the rates of diabetes mellitus, insomnia, LOS, or 30-day readmission rates. A reduced steroid taper after brain tumor surgery significantly reduced the incidence of hypertension without increasing LOS or 30-day readmissions compared with controls treated with a high-dose taper.