Impact of dexamethasone on postoperative inflammatory markers and recovery outcomes in elderly patients undergoing open lumbar surgery

The perioperative use of dexamethasone offers anti-inflammatory benefits, but its effects in elderly patients undergoing open lumbar surgery are unclear. In this randomized, double-blind study, individuals aged 65 years and older received a preoperative intravenous dose of dexamethasone (0.15 mg kg^-1) or placebo. Among 120 enrolled participants, 107 completed all study assessments. On postoperative day 1, plasma C-reactive protein levels were significantly lower with dexamethasone than with placebo (median 10.9 vs. 18.2 mg/L; <i>p</i> < 0.001; median difference 7.1 mg/L, 95% CI 3.5-12.4). Wound drainage was also reduced (median 80 vs. 132.5 mL; <i>p</i> < 0.001; median difference 52.5 mL, 95% CI 32.5-80.0). Patients receiving dexamethasone showed lower early pain scores, improved recovery, and attenuated inflammatory markers. Transient postoperative hyperglycemia occurred without an increase in infections. These findings support a single preoperative dose of dexamethasone mitigated early inflammation and enhanced recovery in older adults after lumbar spine surgery.