Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Diabetic Patients?

IF 2.6 2区医学 Q1 ORTHOPEDICS Journal of the American Academy of Orthopaedic Surgeons Pub Date : 2024-10-18 DOI:10.5435/JAAOS-D-23-00513

Kareem J Kebaish, Jennifer C Wang, Amit S Piple, Julian Wier, Kevin C Liu, Alexander B Christ, Nathanael D Heckmann

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Abstract

Introduction: Dexamethasone is used extensively during total hip and knee arthroplasty total joint arthroplasty (TJA) to control pain and decrease the risk of nausea and vomiting. However, the safety of dexamethasone utilization in diabetic patients is poorly understood. Therefore, this study aims to evaluate complications associated with perioperative dexamethasone administration during primary TJA in diabetic patients.

Methods: The Premier Healthcare Database was queried for all patients with diabetes mellitus who underwent primary elective TJA from 2015 to 2020. Patients who received intravenous dexamethasone on the day of surgery were compared with those who did not. Patient characteristics, hospital factors, and rates of medical comorbidities were assessed and compared between the cohorts. Multivariate logistic regression was done to assess the 90-day risk of infectious and noninfectious postoperative complications.

Results: Overall, 261,474 diabetic patients were included for analysis, 122,631 (46.9%) of whom received dexamethasone. The two cohorts were similar in patient demographics, hospital characteristics, and comorbidity burden (absolute range of differences: 0.00 to 2.33%). Diabetic patients who received dexamethasone had decreased odds of periprosthetic joint infection (adjusted odds ratio 0.82, 95%-CI: 0.75 to 0.90, P < 0.001) and sepsis (aOR: 0.80, 95%-CI: 0.72 to 0.89, P < 0.001) compared with those who did not. Patients who received dexamethasone had shorter length of stay compared with those who did not (1.87 ± 1.60 days vs. 2.27 ± 1.88 days, P < 0.001). The adjusted odds of postoperative hyperglycemia were markedly higher in the dexamethasone group (aOR: 1.14, 95%-CI: 1.10 to 1.18, P < 0.001).

Conclusion: Use of perioperative dexamethasone was not associated with the increased risk of infectious complications among diabetic patients undergoing TJA, supporting its safety in this high-risk population.

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糖尿病患者在全髋关节和膝关节置换术期间使用地塞米松是否安全？

简介：地塞米松在全髋关节和膝关节置换术（TJA）中被广泛使用，以控制疼痛并降低恶心和呕吐的风险。然而，糖尿病患者使用地塞米松的安全性却鲜为人知。因此，本研究旨在评估糖尿病患者在初次 TJA 中围术期使用地塞米松的相关并发症：方法：在 Premier Healthcare 数据库中查询了 2015 年至 2020 年期间接受初级择期 TJA 手术的所有糖尿病患者。将手术当天接受静脉注射地塞米松的患者与未接受静脉注射地塞米松的患者进行比较。对患者特征、医院因素和内科合并症发生率进行了评估，并对两组患者进行了比较。多变量逻辑回归评估了 90 天内感染性和非感染性术后并发症的风险：共有 261,474 名糖尿病患者纳入分析，其中 122,631 人（46.9%）接受了地塞米松治疗。两组患者在人口统计学、医院特征和并发症负担方面相似（差异的绝对范围：0.00 至 2.33%）。与未接受地塞米松治疗的患者相比，接受地塞米松治疗的糖尿病患者发生假体周围关节感染（调整后几率比0.82，95%-CI：0.75至0.90，P＜0.001）和败血症（aOR：0.80，95%-CI：0.72至0.89，P＜0.001）的几率降低。与未接受地塞米松治疗的患者相比，接受地塞米松治疗的患者住院时间更短（1.87 ± 1.60 天 vs. 2.27 ± 1.88 天，P < 0.001）。地塞米松组术后发生高血糖的调整几率明显更高（aOR：1.14，95%-CI：1.10-1.18，P <0.001）：结论：在接受TJA手术的糖尿病患者中，围手术期使用地塞米松与感染并发症风险的增加无关，这支持了地塞米松在这一高风险人群中的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Academy of Orthopaedic Surgeons 医学-整形外科

CiteScore

6.10

自引率

6.20%

发文量

529

审稿时长

4-8 weeks

期刊介绍： The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues. Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.