Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Vantaa, Finland.
Int Orthop. 2019 Aug;43(8):1787-1792. doi: 10.1007/s00264-018-4156-8. Epub 2018 Sep 19.
Dexamethasone has been shown to prevent post-operative nausea and vomiting (PONV) and seems to reduce post-operative pain. Both factors, which can extend the hospital stay, delay rehabilitation, and impact patient satisfaction. Because of the immunosuppressive and glucose-rising effects of dexamethasone, there has been concern of its safety in arthroplasty surgery. The purpose of our study was to examine infection safety of dexamethasone in arthroplasty surgery with enough large study material to reliably detect a possible, even small, difference in infection incidence.
A total of 18,872 consecutive primary and revision hip and knee arthroplasties were analyzed with data gathered from clinical information databases and a surgical site infection surveillance database with prospective data collection. Also, emergency operations due to fractures were included except for hip hemiarthroplasties.
During the follow-up, 189 (1.0%) prosthetic joint infections (PJIs) occurred: 0.8% after primary arthroplasty and 1.9% after revision arthroplasty. Dexamethasone was used in 2922 (15.5%) operations. The PJI rate in the dexamethasone group was 1.1% (31/2922) and in the non-dexamethasone group 1.0% (161/15950), with no significant difference in the risk of PJI between the two groups (OR 1.052, 95% CI 0.715-1.548, P = 0.773).
In our study material, the use of a single 5-10 mg dose of dexamethasone did not increase the incidence of post-operative PJI. A low dose of dexamethasone may be safely used to prevent PONV and as part of multimodal analgesia on patients undergoing arthroplasty operation.
地塞米松已被证明可预防术后恶心和呕吐（PONV），并似乎可减轻术后疼痛。这两个因素都会延长住院时间、延迟康复并影响患者满意度。由于地塞米松具有免疫抑制和升糖作用，因此人们担心其在关节置换手术中的安全性。我们研究的目的是检查地塞米松在关节置换手术中的感染安全性，使用足够大的研究材料来可靠地检测感染发生率的可能差异，即使这种差异很小。
共分析了 18872 例连续的初次和翻修髋关节和膝关节置换术，这些数据来自临床信息数据库和手术部位感染监测数据库，这些数据库均进行前瞻性数据收集。此外，还包括因骨折而进行的急诊手术，但髋关节半髋关节置换术除外。
在随访期间，发生了 189 例（1.0%）假体关节感染（PJI）：初次置换后为 0.8%，翻修置换后为 1.9%。在 2922 例（15.5%）手术中使用了地塞米松。地塞米松组的 PJI 发生率为 1.1%（31/2922），非地塞米松组为 1.0%（161/15950），两组 PJI 风险无显著差异（OR 1.052，95%CI 0.715-1.548，P=0.773）。
在我们的研究资料中，单次使用 5-10mg 剂量的地塞米松并未增加术后 PJI 的发生率。小剂量地塞米松可安全用于预防 PONV，并作为接受关节置换手术患者多模式镇痛的一部分。
