EPID-27. Rapid Dexamethasone Withdrawal After Glioma Resection Decreases Early Readmission: Target-Trial Emulation on TriNetX

Abstract INTRODUCTION Post-resection cerebral oedema in glioma is routinely managed with high-dose dexamethasone, yet practice varies widely: U.S. surveys show most surgeons still prescribe 16 mg/day with a four-week taper, while others discontinue within a few days. Prolonged exposure is not benign, which may lead to early surgical-site infection, hypertension, and unplanned ICU readmission. Despite these signals, no large multi-institutional analysis has tested whether shortening the dexamethasone course truly lowers 90-day unplanned readmission after glioma surgery. Our study emulates a target trial comparing a ≤ 7-day taper versus routine longer taper. Clarifying this relationship could provide an immediate, low-cost strategy to improve peri-operative care and downstream outcomes in high-grade glioma. METHODS We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, a multicenter database that includes 71 healthcare organizations nationwide. Glioma patients who underwent surgery were classified into two groups according to glucocorticoid taper duration: early taper (≤ 7 days) and late taper (> 7 days). Propensity-score matching (1:1) was applied to balance baseline characteristics. Outcomes, including all-cause mortality, hospital readmission, emergency department visit, and ICU readmission, were assessed from postoperative day 30 through day 90. RESULTS A total of 11,398 patients with early taper and 14,425 patients with late taper were included in the study. After 1:1 propensity score matching, baseline characteristics were well balanced (standardized mean differences < 0.1; mean age: 48.9 ± 21.2 vs. 48.8 ± 21.7). Early taper were associated with lower all-cause mortality (hazard ratio [HR] 0.362; 95% CI, 0.311–0.421), hospital readmission (0.253 [0.235,0.272]), emergency department visit (0.362 [0.332,0.394]), and ICU readmission (0.201[0.165,0.245]). CONCLUSION Rapid glucocorticoid taper were related to preferrable outcomes.