{
  "abstract": "BackgroundIn Denmark, high-dose perioperative glucocorticoids were implemented stepwise for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA). We aimed to estimate the opioid-sparing effect of adding a single high dose of glucocorticoids to the analgesic regimen.\n\nMethodsIn this prespecified analysis of a multicentre natural experiment using electronic health record data, we included all elective THA, TKA, or UKA procedures performed in Eastern Denmark from 2017-2025, with no exclusion criteria. At each centre, procedures before implementation of high-dose glucocorticoids served as controls, whereas procedures after implementation comprised the intervention group. A high dose was defined as [≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone. The primary outcome was the adjusted between-group difference in 0-24h opioid consumption. The minimal important difference was 5 mg IV morphine equivalents. Secondary outcomes were maximum 0-10 numerical rating scale (NRS) pain score, incidence of opioid-related adverse events, hospital length of stay, and days alive and out of hospital at 30 days.\n\nResultsWe analysed 47,317 procedures performed at nine centres: 13,010 controls and 34,307 in the intervention group. During the study period, five of nine centres implemented high-dose glucocorticoids for THA patients, two of eight for TKA/UKA patients. High-dose glucocorticoids were administered to 6% and 92% of patients before and after implementation, respectively. The implementation was associated with an adjusted mean reduction of 3.8 mg IV morphine equivalents (95% CI 3.3-4.3) and a 0.8-point lower maximum recorded pain score (99% CI 0.7-0.9) in the first 24 hours, with no statistically significant differences in the remaining outcomes.\n\nConclusionsImplementation of high-dose glucocorticoids was associated with only a small drop in opioid consumption, below the minimal important difference.\n\nKey Points SummaryO_LIQuestion: What opioid-sparing effects may be expected when adding high-dose glucocorticoids ([≥]16 mg or 0.2 mg/kg dexamethasone or [≥]80 mg methylprednisolone) to the standard analgesic package for patients undergoing total hip and knee arthroplasty? C_LIO_LIFindings: In Eastern Denmark, the adoption of high-dose glucocorticoids to the existing multimodal analgesic regimen was associated with a slightly lower 0-to-24 hours in-hospital opioid consumption, according to electronic health record data. C_LIO_LIMeaning: Clinicians may expect a slightly lower opioid-sparing effect from high-dose glucocorticoids than found in randomised clinical trials. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Bispebjerg University Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "J. Laigaard"
    },
    {
      "name": "M. O. Moeller"
    },
    {
      "name": "M. H. Olsen"
    },
    {
      "name": "S. Overgaard"
    },
    {
      "name": "O. Mathiesen"
    },
    {
      "name": "A. P. H. Karlsen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/aca104khz4hkn.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.31.26361793",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v1.full",
  "id": "aca104khz4hkn",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "pain medicine"
    ],
    [
      "openalex",
      "2746|Anesthesia and Pain Management"
    ]
  ],
  "openalex": "W7206184123",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-31",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/aca104khz4hkn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "10.64898/2026.08.31.26361793",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.31.26361793v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:pain medicine",
      "subfield": "surgery"
    }
  ],
  "title": "The effect of high-dose glucocorticoids on opioid consumption in the first 24 hours after elective hip and knee arthroplasty: A natural experiment study of 47,317 surgeries in Eastern Denmark",
  "title_text": "The effect of high-dose glucocorticoids on opioid consumption in the first 24 hours after elective hip and knee arthroplasty: A natural experiment study of 47,317 surgeries in Eastern Denmark",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:54Z",
  "url": "https://research.draconitic.com/paper/aca104khz4hkn",
  "venue": "medRxiv",
  "versions": []
}