The effect of dexamethasone on inflammatory markers of surgical stress: a randomized trial in robotic hysterectomy

Karsten Kaiser; Sven Hoedt Karstensen; Sofie Ronja Petersen; Kristian Als Nielsen; Alexandros Valsamidis Valorenzos; Thomas Strøm; Ismail Gögenur; Lukas Balsevicius; Finn Friis Lauszus

doi:10.1186/s12893-026-03664-y

The effect of dexamethasone on inflammatory markers of surgical stress: a randomized trial in robotic hysterectomy

Karsten Kaiser^*
, Sven Hoedt Karstensen
, Sofie Ronja Petersen
, Kristian Als Nielsen
, Alexandros Valsamidis Valorenzos
, Thomas Strøm
, Ismail Gögenur
, Lukas Balsevicius
, Finn Friis Lauszus

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissue damage and hasten recovery by attenuating the inflammatory response, modulating immune cell activity, and reducing the release of pro-inflammatory cytokines. In this first randomized trial of dexamethasone in robotic hysterectomy, we aimed to evaluate its effect on reducing C-reactive protein (CRP) as a proxy marker of surgical stress.

METHODS: Women scheduled for robotic-assisted hysterectomy were recruited into a randomized trial comparing a preoperative dose of 24 mg dexamethasone with placebo. Blood tests were obtained, and visual analogue scale scores for pain, postoperative nausea and vomiting, and medication use during admission were recorded at 0, 4, 8, 12, and 24 h postoperatively.

RESULTS: Among the 112 included women, postoperative CRP levels were lower in the dexamethasone group at 12 and 24 h. Postoperative nausea and vomiting over time were also reduced in the dexamethasone group (p = 0.039 without adjustment; p = 0.02 with adjustment). Changes in CRP were analyzed using repeated-measures analysis, showing highly significant differences both without and with adjustment for BMI, age, and baseline CRP (both p < 0.001). Overall, the dexamethasone group demonstrated substantially lower CRP levels during the postoperative period.

CONCLUSION: Dexamethasone significantly reduced postoperative CRP levels, suggesting a potential role in further reducing surgical stress in robotic-assisted hysterectomy.

TRIAL REGISTRATION: European medical agency (EUDRACT no.2021-000874-28). 02.06.2021. CTIS Public Portal (European Medicines Agency) Registry of randomized clinical trials: NCT04762381, "Effect of 24mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy", 11th March 2022.

CLINICALTRIALS: gov.

Original language	English
Journal	BMC Surgery
Volume	26
Issue number	1
Early online date	3 Jun 2026
DOIs	https://doi.org/10.1186/s12893-026-03664-y
Publication status	Published - 3 Jun 2026

Keywords

Adult
Anti-Inflammatory Agents/therapeutic use
Biomarkers/blood
C-Reactive Protein/metabolism
Dexamethasone/therapeutic use
Double-Blind Method
Female
Glucocorticoids/therapeutic use
Humans
Hysterectomy/methods
Middle Aged
Postoperative Nausea and Vomiting/prevention & control
Postoperative Pain/prevention & control
Robotic Surgical Procedures/adverse effects

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10.1186/s12893-026-03664-y

Cite this

@article{011e1ec5d4de492f854e607c6fcdeb8a,

title = "The effect of dexamethasone on inflammatory markers of surgical stress: a randomized trial in robotic hysterectomy",

abstract = "BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissue damage and hasten recovery by attenuating the inflammatory response, modulating immune cell activity, and reducing the release of pro-inflammatory cytokines. In this first randomized trial of dexamethasone in robotic hysterectomy, we aimed to evaluate its effect on reducing C-reactive protein (CRP) as a proxy marker of surgical stress.METHODS: Women scheduled for robotic-assisted hysterectomy were recruited into a randomized trial comparing a preoperative dose of 24 mg dexamethasone with placebo. Blood tests were obtained, and visual analogue scale scores for pain, postoperative nausea and vomiting, and medication use during admission were recorded at 0, 4, 8, 12, and 24 h postoperatively.RESULTS: Among the 112 included women, postoperative CRP levels were lower in the dexamethasone group at 12 and 24 h. Postoperative nausea and vomiting over time were also reduced in the dexamethasone group (p = 0.039 without adjustment; p = 0.02 with adjustment). Changes in CRP were analyzed using repeated-measures analysis, showing highly significant differences both without and with adjustment for BMI, age, and baseline CRP (both p < 0.001). Overall, the dexamethasone group demonstrated substantially lower CRP levels during the postoperative period.CONCLUSION: Dexamethasone significantly reduced postoperative CRP levels, suggesting a potential role in further reducing surgical stress in robotic-assisted hysterectomy.TRIAL REGISTRATION: European medical agency (EUDRACT no.2021-000874-28). 02.06.2021. CTIS Public Portal (European Medicines Agency) Registry of randomized clinical trials: NCT04762381, {"}Effect of 24mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy{"}, 11th March 2022.CLINICALTRIALS: gov.",

keywords = "Adult, Anti-Inflammatory Agents/therapeutic use, Biomarkers/blood, C-Reactive Protein/metabolism, Dexamethasone/therapeutic use, Double-Blind Method, Female, Glucocorticoids/therapeutic use, Humans, Hysterectomy/methods, Middle Aged, Postoperative Nausea and Vomiting/prevention \& control, Postoperative Pain/prevention \& control, Robotic Surgical Procedures/adverse effects",

author = "Karsten Kaiser and Karstensen, \{Sven Hoedt\} and Petersen, \{Sofie Ronja\} and Nielsen, \{Kristian Als\} and Valorenzos, \{Alexandros Valsamidis\} and Thomas Str{\o}m and Ismail G{\"o}genur and Lukas Balsevicius and Lauszus, \{Finn Friis\}",

note = "{\textcopyright} 2026. The Author(s).",

year = "2026",

month = jun,

day = "3",

doi = "10.1186/s12893-026-03664-y",

language = "English",

volume = "26",

journal = "BMC Surgery",

issn = "1471-2482",

publisher = "BioMed Central Ltd.",

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TY - JOUR

T1 - The effect of dexamethasone on inflammatory markers of surgical stress

T2 - a randomized trial in robotic hysterectomy

AU - Kaiser, Karsten

AU - Karstensen, Sven Hoedt

AU - Petersen, Sofie Ronja

AU - Nielsen, Kristian Als

AU - Valorenzos, Alexandros Valsamidis

AU - Strøm, Thomas

AU - Gögenur, Ismail

AU - Balsevicius, Lukas

AU - Lauszus, Finn Friis

PY - 2026/6/3

Y1 - 2026/6/3

N2 - BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissue damage and hasten recovery by attenuating the inflammatory response, modulating immune cell activity, and reducing the release of pro-inflammatory cytokines. In this first randomized trial of dexamethasone in robotic hysterectomy, we aimed to evaluate its effect on reducing C-reactive protein (CRP) as a proxy marker of surgical stress.METHODS: Women scheduled for robotic-assisted hysterectomy were recruited into a randomized trial comparing a preoperative dose of 24 mg dexamethasone with placebo. Blood tests were obtained, and visual analogue scale scores for pain, postoperative nausea and vomiting, and medication use during admission were recorded at 0, 4, 8, 12, and 24 h postoperatively.RESULTS: Among the 112 included women, postoperative CRP levels were lower in the dexamethasone group at 12 and 24 h. Postoperative nausea and vomiting over time were also reduced in the dexamethasone group (p = 0.039 without adjustment; p = 0.02 with adjustment). Changes in CRP were analyzed using repeated-measures analysis, showing highly significant differences both without and with adjustment for BMI, age, and baseline CRP (both p < 0.001). Overall, the dexamethasone group demonstrated substantially lower CRP levels during the postoperative period.CONCLUSION: Dexamethasone significantly reduced postoperative CRP levels, suggesting a potential role in further reducing surgical stress in robotic-assisted hysterectomy.TRIAL REGISTRATION: European medical agency (EUDRACT no.2021-000874-28). 02.06.2021. CTIS Public Portal (European Medicines Agency) Registry of randomized clinical trials: NCT04762381, "Effect of 24mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy", 11th March 2022.CLINICALTRIALS: gov.

AB - BACKGROUND AND AIM: The immunosuppressive action of dexamethasone may help reduce the risk of postoperative complications such as infection, adhesion formation, and delayed wound healing. Dexamethasone may mitigate tissue damage and hasten recovery by attenuating the inflammatory response, modulating immune cell activity, and reducing the release of pro-inflammatory cytokines. In this first randomized trial of dexamethasone in robotic hysterectomy, we aimed to evaluate its effect on reducing C-reactive protein (CRP) as a proxy marker of surgical stress.METHODS: Women scheduled for robotic-assisted hysterectomy were recruited into a randomized trial comparing a preoperative dose of 24 mg dexamethasone with placebo. Blood tests were obtained, and visual analogue scale scores for pain, postoperative nausea and vomiting, and medication use during admission were recorded at 0, 4, 8, 12, and 24 h postoperatively.RESULTS: Among the 112 included women, postoperative CRP levels were lower in the dexamethasone group at 12 and 24 h. Postoperative nausea and vomiting over time were also reduced in the dexamethasone group (p = 0.039 without adjustment; p = 0.02 with adjustment). Changes in CRP were analyzed using repeated-measures analysis, showing highly significant differences both without and with adjustment for BMI, age, and baseline CRP (both p < 0.001). Overall, the dexamethasone group demonstrated substantially lower CRP levels during the postoperative period.CONCLUSION: Dexamethasone significantly reduced postoperative CRP levels, suggesting a potential role in further reducing surgical stress in robotic-assisted hysterectomy.TRIAL REGISTRATION: European medical agency (EUDRACT no.2021-000874-28). 02.06.2021. CTIS Public Portal (European Medicines Agency) Registry of randomized clinical trials: NCT04762381, "Effect of 24mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy", 11th March 2022.CLINICALTRIALS: gov.

KW - Adult

KW - Anti-Inflammatory Agents/therapeutic use

KW - Biomarkers/blood

KW - C-Reactive Protein/metabolism

KW - Dexamethasone/therapeutic use

KW - Double-Blind Method

KW - Female

KW - Glucocorticoids/therapeutic use

KW - Humans

KW - Hysterectomy/methods

KW - Middle Aged

KW - Postoperative Nausea and Vomiting/prevention & control

KW - Postoperative Pain/prevention & control

KW - Robotic Surgical Procedures/adverse effects

U2 - 10.1186/s12893-026-03664-y

DO - 10.1186/s12893-026-03664-y

M3 - Article

C2 - 42237296

SN - 1471-2482

VL - 26

JO - BMC Surgery

JF - BMC Surgery

IS - 1

ER -

The effect of dexamethasone on inflammatory markers of surgical stress: a randomized trial in robotic hysterectomy

Abstract

Keywords

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