初次全关节置换术中围手术期静脉注射不同剂量地塞米松的安全性：一项回顾性大规模队列研究
Safety of perioperative intravenous different doses of dexamethasone in primary total joint arthroplasty: a retrospective large-scale cohort study.
作者信息
Mou Ping, Zhao Xiao-Dan, Tang Xiu-Mei, Liu Zun-Han, Wang Hao-Yang, Zeng Wei-Nan, Wang Duan, Zhou Zong-Ke
机构信息
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China.
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
出版信息
BMC Musculoskelet Disord. 2024 Dec 26;25(1):1067. doi: 10.1186/s12891-024-08225-z.
PURPOSE
Perioperative intravenous different doses of dexamethasone (DEX) can realize effective clinical outcomes in total joint arthroplasty (TJA). However, the effect of different DEX doses on readmission rates and postoperative complications remains unclear.
METHODS
We retrospectively analyzed patients who underwent primary TJA between December 2012 and October 2020. Patients were categorized into three groups based on the total perioperative dose of DEX: control group (DEX = 0 mg), low-dose group (DEX < 15 mg), and high-dose group (DEX ≥ 15 mg). Primary outcomes included 30-day and 90-day readmission rates. Secondary outcomes included the rates of periprosthetic joint infection (PJI) and wound complications, with treatment outcomes for these complications were also evaluated. Multivariable analysis was used to identify risk factors for readmission.
RESULTS
A total of 14,557 procedures were included, with 6,686 in the control group, 4,325 in the low-dose group, and 3,546 in the high-dose group. No significant differences were observed among the groups for 30-day (p = 0.645) or 90-day readmission rates (p = 0.539). Additionally, there were no significant differences in rates of PJI (p = 0.401) or wound complications (p = 0.079). Treatment for PJI and wound complications was successful across all groups. Risk factors for 30-day readmission included age > 80 years (OR: 2.585, 95% CI: 1.123-5.954, p = 0.026) and undergoing total hip arthroplasty (THA) (OR: 1.692, 95% CI: 1.137-2.518, p = 0.009). For 90-day readmission, age 71-80 years (OR: 2.199, 95% CI: 1.349-3.583, p = 0.002), age > 80 years (OR: 3.897, 95% CI: 1.966-7.727, p < 0.001), and THA (OR: 1.622, 95% CI: 1.179-2.230, p = 0.003) were significant risk factors. However, neither low-dose nor high-dose DEX was associated with increased 30-day or 90-day readmission rates.
CONCLUSIONS
Perioperative intravenous DEX may be not associated with the readmission, PJI, and wound complications in patients undergoing primary TJA.
目的
围手术期静脉注射不同剂量的地塞米松（DEX）可在全关节置换术（TJA）中实现有效的临床效果。然而，不同剂量的DEX对再入院率和术后并发症的影响仍不清楚。
方法
我们回顾性分析了2012年12月至2020年10月期间接受初次TJA的患者。根据围手术期DEX的总剂量将患者分为三组：对照组（DEX = 0 mg）、低剂量组（DEX < 15 mg）和高剂量组（DEX≥15 mg）。主要结局包括30天和90天再入院率。次要结局包括假体周围关节感染（PJI）和伤口并发症的发生率，并对这些并发症的治疗结果进行了评估。采用多变量分析确定再入院的危险因素。
结果
共纳入14557例手术，其中对照组6686例，低剂量组4325例，高剂量组3546例。三组之间在30天（p = 0.645）或90天再入院率（p = 0.539）方面未观察到显著差异。此外，PJI发生率（p = 0.401）或伤口并发症发生率（p = 0.079）也无显著差异。所有组对PJI和伤口并发症的治疗均成功。30天再入院的危险因素包括年龄>80岁（OR：2.585，95%CI：1.123 - 5.954，p = 0.026）和接受全髋关节置换术（THA）（OR：1.692，95%CI：1.137 - 2.518，p = 0.009）。对于90天再入院，71 - 80岁（OR：2.199，95%CI：1.349 - 3.583，p = 0.002）、年龄>80岁（OR：3.897，95%CI：1.966 - 7.727，p < 0.001）和THA（OR：1.622，95%CI：1.179 - 2.230，p = 0.003）是显著的危险因素。然而，低剂量和高剂量的DEX均与30天或90天再入院率的增加无关。
结论
围手术期静脉注射DEX可能与接受初次TJA的患者的再入院、PJI和伤口并发症无关。
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