A Reduced Exogenous Steroid Taper (REST) for postoperative brain tumor patients - a case-control study.

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A Reduced Exogenous Steroid Taper (REST) for postoperative brain tumor patients - a case-control study.

World Neurosurg. 2019 Jan 10;:

Authors: Breshears JD, Haddad AF, Viner J, Rau J, Sankaran S, McDermott MW

Abstract
BACKGROUND: Dexamethasone is a standard treatment for cerebral edema following 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.
OBJECTIVE: 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.
METHODS: A REST protocol (dexamethasone 38.5 mg tapered over 10 days) was instituted for postoperative brain tumor patients 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.
RESULTS: Twenty-five patients were included in each group. There were no significant differences in baseline characteristics. The REST group received a median of 34.5mg [interquartile range (IQR) 32mg-41mg] of dexamethasone, while controls received 43mg [IQR 16 - 91mg] (p = 0.04). There was a significant reduction in the incidence of new or worsened hypertension in the REST group (0%) compared to controls (20%, p = 0.02). No difference was seen in the rates of DM, insomnia, LOS, or 30-day readmission rates.
CONCLUSION: A reduced steroid taper following brain tumor surgery significantly reduced the incidence of hypertension without increasing LOS or 30-day re-admissions compared to controls treated with a high dose taper.

PMID: 30639502 [PubMed - as supplied by publisher]

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