Perioperative Dexamethasone is Associated with a Decreased Risk of Pulmonary Embolism and Deep Vein Thrombosis Following Total Joint Arthroplasty: An Analysis of 70,000 High-Risk Patients

Brandon S Gettleman; Kevin C Liu; Brandon Yoshida; Andrew N Vega; Nicholas Kusnezov; Jay R Lieberman; Nathanael D Heckmann

doi:10.1016/j.arth.2024.05.020

Perioperative Dexamethasone is Associated with a Decreased Risk of Pulmonary Embolism and Deep Vein Thrombosis Following Total Joint Arthroplasty: An Analysis of 70,000 High-Risk Patients

J Arthroplasty. 2024 May 10:S0883-5403(24)00453-4. doi: 10.1016/j.arth.2024.05.020. Online ahead of print.

Authors

Brandon S Gettleman¹, Kevin C Liu¹, Brandon Yoshida¹, Andrew N Vega¹, Nicholas Kusnezov¹, Jay R Lieberman¹, Nathanael D Heckmann²

Affiliations

¹ Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
² Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California. Electronic address: nate.heckmann@gmail.com.

PMID: 38735549
DOI: 10.1016/j.arth.2024.05.020

Abstract

Background: Dexamethasone (DEX) has demonstrated promise with respect to decreasing postoperative thromboembolic complications following total joint arthroplasty (TJA). Therefore, the aim of this study was to investigate the effects of perioperative intravenous DEX on rates of pulmonary embolism (PE) and deep vein thrombosis (DVT) after primary TJA in patients who have a history of venous thromboembolism (VTE).

Methods: Patients who have a history of VTE who underwent primary, elective TJA from 2015 to 2021 were identified using a commercial healthcare database. Patients were divided based on receipt of perioperative intravenous DEX [DEX(+) versus DEX(-)] on the day of index TJA. Patient demographics and hospital factors were collected. The 90-day risk of postoperative complications, readmission, and in-hospital mortality were compared.

Results: Overall, 70,147 patients who had a history of VTE underwent TJA, of which 40,607 (57.89%) received DEX and 29,540 (42.11%) did not. The DEX(+) patients were younger (67 ± 9.8 versus 68 ± 9.9 years, P < 0.001) and had a significantly shorter length of stay compared to the DEX(-) patients (1.8 ± 1.6 versus 2.2 ± 1.8 days, P < 0.001). The DEX(+) patients demonstrated lower rates of PE (1.37 versus 1.75%, P < 0.001) and DVT (2.37 versus 3.01%, P < 0.001) compared to DEX(-) patients. The DEX(+) patients experienced a lower risk of PE (adjusted odds ratio [aOR] 0.78, 95% confidence interval [95%-CI]: 0.66 to 0.93, P = 0.006) and DVT (aOR: 0.84, 95%-CI: 0.74 to 0.95, P = 0.006) compared to DEX(-) patients. The DEX(+) patients demonstrated no differences in the odds of surgical site infection, periprosthetic joint infection, or sepsis compared to the DEX(-) patients (P > 0.05).

Conclusion: The administration of DEX was associated with a decreased risk of PE and DVT in patients who have a history of VTE who underwent TJA. These data warrant further study investigating the postoperative benefits of perioperative DEX administration for high-risk patients undergoing TJA.

Keywords: Total joint arthroplasty; deep vein thrombosis; dexamethasone; pulmonary embolism; venous thromboembolism.