Single-dose dexamethasone,
does it really help with No clinically unacceptable increase in 30-day surgical-site infection with reduced postoperative nausea and vomiting after noncardiac surgery?
research showsThe grade is B with 76 points. PADDI was a large triple-blind trial that randomized 8,880 patients. In the prespecified modified intention-to-treat population of 8,725, 8,678 had primary-outcome data; 30-day surgical-site infection occurred in 8.1% versus 9.1%, with a diabetes-adjusted risk difference of -0.9 points (95.6% CI -2.1 to 0.3), meeting the prespecified 2.0-point noninferiority margin. Nausea or vomiting within 24 hours also fell from 53.9% to 42.2%. The noninferiority design limits the grade to B.
ads claimThis evidence concerns one 8-mg dose after induction for nonurgent noncardiac surgery. It does not establish repeated high-dose steroid use, infection treatment, or use in every surgical population.
Useful facts when choosing a product
- The registration is ACTRN12614001226695.
- The prespecified primary population was modified intention-to-treat, 8,725 patients, with primary outcome data in 8,678.
- The 2.0-point noninferiority margin was prespecified using a modified Delphi process.
What the research actually shows
The trial randomized 8,880 adults in Australia, Hong Kong, New Zealand, and South Africa to dexamethasone 8 mg or placebo. The paper's prespecified primary population was the modified intention-to-treat set of 8,725 who met surgery and anesthesia-induction criteria; 8,678 had primary-outcome data. The 8,116-person per-protocol and as-treated analyses assessed consistency. These populations should not be conflated in a noninferiority trial. Infection was 8.1% versus 9.1%, adjusted risk difference -0.9 points (95.6% CI -2.1 to 0.3), P<.001 for noninferiority. Nausea or vomiting within 24 hours was 42.2% versus 53.9%, RR 0.78 (95% CI 0.75 to 0.82), absolute difference -11.7 points. Funding came from the Australian NHMRC, Research Grants Council of Hong Kong, and Monash University; the paper states, 'There was no commercial involvement in the trial.'
Why this is classified as B (76)
A large publicly funded triple-blind hard-outcome trial met a prespecified 2.0-point margin, but one noninferiority trial gives B with 76 points.
Counterpoint. Nausea and vomiting clearly decreased, but small increases in hyperglycemia and insulin use and the six-month pain signal require attention.
Rejudgment record. Cross-check applied — One large independent triple-blind hard-outcome trial met its prespecified noninferiority margin, but independent replication is absent and noninferiority design remains a limitation
| Endpoint | H | Hard endpoint - actual events such as death |
| Replication | R1 | Single confirmatory trial |
| Independence | I2 | Decisive evidence is publicly or non-profit funded |
| Effect size | E+ | Meets the clinically important threshold |
The scoring table and the verdict agree (B).
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Noninferiority for 30-day surgical-site infection | B | Rates were 8.1% versus 9.1% and met the 2.0-point margin. |
| Reduced nausea or vomiting within 24 hours | B | Rates were 42.2% versus 53.9%, RR 0.78. |
Cross-check — Codex and Claude
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Study 1 | Multinational triple-blind placebo-controlled randomized noninferiority trial | 8,116 | Australian NHMRC, Research Grants Council of Hong Kong, and Monash University; no commercial involvement | Surgical-site infection within 30 days | 8.1% versus 9.1%; diabetes-adjusted risk difference -0.9 points (95.6% CI -2.1 to 0.3), noninferiority P<.001; nausea or vomiting 42.2% versus 53.9% | Large independent single hard-outcome trial |
Receipt — 1 References
All 1 cited sources were verified for existence at the original page (as of 2026-08-18).
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-08-18 · Corrections: none
Cite this verdict
[Chamgap] Single-dose dexamethasone x surgical-site infection after noncardiac surgery — Evidence Grade B·76. 1 cited sources checked. Source: https://chamgap.com/en/verdicts/general/single-dose-dexamethasone-noncardiac-surgery-surgical-site-infection/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
What this document does and does not do
Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.