Perioperative IV dexamethasone not associated with PJI, wound complications after TSA
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Key takeaways:
- Use of perioperative IV dexamethasone may be safe and effective for patients undergoing shoulder arthroplasty.
- Dexamethasone was not associated with increased risk of infection or wound complications.
According to published results, use of perioperative IV dexamethasone was not associated with increased risk of periprosthetic joint infection or wound healing complications after total shoulder arthroplasty.
Researchers from the Keck School of Medicine at the University of Southern California analyzed data from 135,333 adults who underwent elective shoulder arthroplasty between 2016 and 2020. According to the study, 61.2% of patients underwent reverse TSA, 33.8% underwent anatomic TSA and 5% underwent hemiarthroplasty.
Researchers compared outcomes between 89,266 patients (mean age, 69.1 years) who received a mean of 11 mg of IV dexamethasone perioperatively and 46,067 patients (mean age, 69.9 years) who did not receive dexamethasone. Outcomes included PJI, wound infection and wound dehiscence at 90-day follow-up, as well as pulmonary, renal and thromboembolic complications.
Researchers noted use of perioperative IV dexamethasone increased by 135% during the study period.
“The rate of IV dexamethasone use appears to be rising in patients undergoing TSA, likely due to increased recognition of its beneficial effects as part of a perioperative medication regimen,” the researchers wrote in the study.
They found patients who received dexamethasone had no increased risk for PJI, superficial wound infection or wound dehiscence compared with patients who did not receive dexamethasone. They found dexamethasone was associated with decreased risks of 90-day readmission (OR = 0.88), sepsis (OR = 0.67), urinary tract infection (OR = 0.76) and acute kidney injury (OR = 0.82).
“The results of this study support the safety of perioperative IV dexamethasone use in patients undergoing elective TSA,” researchers concluded.
Perspective
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The number of total joint replacements are going up exponentially in the U.S., and shoulder replacement has been at the forefront of that growth. With the increasing number of total shoulder procedures performed, additional research is paramount to understand how to best optimize the experience and minimize risk.
The authors of this paper evaluated dexamethasone. Dexamethasone is widely utilized for the avoidance of postoperative medical complications, but dexamethasone is a corticosteroid. As a steroid, the medication would have the theoretical potential to increase the risk of infections. The authors chose to evaluate this with the Premier Healthcare Database, and I agree with their approach. Any potential increase in infection rates would likely have a relatively low occurrence, and thus, a large sample size is critical. This dataset provided more than 135,000 shoulder replacements, and the findings were encouraging.
Their study demonstrated that dexamethasone was not associated with acute infectious problems or wound healing complications. Their data went even further to suggest patients who received perioperative dexamethasone had a decreased likelihood of medical complications. Overall, this paper well addressed the safety and continued routine use of IV dexamethasone in association with shoulder arthroplasty.
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