Heckmann Nathanael D, Wang Jennifer C, Piple Amit S, Marshall Glenda A, Mills Emily S, Liu Kevin C, Lieberman Jay R, Christ Alexander B
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California.
J Arthroplasty. 2023 Feb;38(2):224-231.e1. doi: 10.1016/j.arth.2022.08.028. Epub 2022 Aug 27.
Intraoperative dexamethasone can reduce postoperative pain and nausea following total knee (TKA) and total hip arthroplasty (THA). To the best of our knowledge, no study to date has been adequately powered to detect the risk of periprosthetic joint infection (PJI) from early dexamethasone exposure. This study aimed to assess PJI rates and complications in patients undergoing primary elective TKA and THA who received intraoperative dexamethasone.
A national database was used to identify adults undergoing primary elective TKA and THA between 2015 and 2020. Patients who received intraoperative dexamethasone and those who did not were identified. The primary endpoint was 90-day risk of infectious complications. Secondary end points included thromboembolic, pulmonary, renal, and wound complications. Multivariate analyses were performed to assess the risk of all endpoints between cohorts. Between 2015 and 2020, 1,322,025 patients underwent primary elective TJA, of which 857,496 (64.1%) underwent TKA and 474,707 (35.9%) underwent TKA.
In patients who underwent TKA, dexamethasone was associated with lower risk of PJI (adjusted odds ratio: 0.87, 95% CI: 0.82-0.93, P < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, and acute kidney injury. In patients who underwent THA, dexamethasone was associated with a lower risk of PJI (adjusted odds ratio: 0.80, 95% CI: 0.73-0.86, P < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, acute kidney injury, and pneumonia.
Intraoperative dexamethasone was not associated with increased risk of infectious complications. The data presented here provide evidence in support of intraoperative dexamethasone utilization during primary TKA or THA.
术中使用地塞米松可减轻全膝关节置换术（TKA）和全髋关节置换术（THA）后的疼痛和恶心。据我们所知，迄今为止尚无研究有足够的效力来检测早期使用地塞米松导致假体周围关节感染（PJI）的风险。本研究旨在评估接受术中地塞米松治疗的初次择期TKA和THA患者的PJI发生率及并发症情况。
使用一个全国性数据库来识别2015年至2020年间接受初次择期TKA和THA的成年人。确定接受术中地塞米松治疗的患者和未接受该治疗的患者。主要终点是90天内发生感染性并发症的风险。次要终点包括血栓栓塞、肺部、肾脏和伤口并发症。进行多变量分析以评估两组之间所有终点的风险。2015年至2020年间，1322025例患者接受了初次择期全关节置换术（TJA），其中857496例（64.1%）接受了TKA，474707例（35.9%）接受了THA。
在接受TKA的患者中，地塞米松与较低的PJI风险相关（调整后的优势比：0.87，95%置信区间：0.82 - 0.93，P <.001），以及与其他次要终点如肺栓塞、深静脉血栓形成和急性肾损伤相关。在接受THA的患者中，地塞米松与较低的PJI风险相关（调整后的优势比：0.80，95%置信区间：0.73 - 0.86，P <.001），以及与其他次要终点如肺栓塞、深静脉血栓形成、急性肾损伤和肺炎相关。
术中使用地塞米松与感染性并发症风险增加无关。此处呈现的数据为在初次TKA或THA期间使用术中地塞米松提供了支持证据。
