Dexamethasone Is Associated With Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty.

Abstract

The utilization of cemented femoral fixation during total hip arthroplasty (THA) has increased in recent years. Perioperative corticosteroids have been shown to attenuate the inflammatory cascade associated with cement-induced cardiopulmonary complications. Therefore, the purpose of this study was to determine if dexamethasone (DEX) utilization was associated with decreased perioperative pulmonary complications associated with cemented THA. Patients who underwent a cemented THA from January 1, 2015, to December 31, 2021, were identified using a nationwide medical database. There were two cohorts identified: patients who received intravenous DEX [DEX(+)] and those who did not [DEX(-)] on the day of surgery. The 90-day risk of pulmonary complications was compared between the DEX(+) and DEX(-) cohorts. Multivariable analyses accounting for potentially confounding variables, including demographic, comorbidity, and venous thromboembolic chemoprophylactic agents, were performed. In total, 27,017 cemented THAs were identified, of which 14,743 (54.6%) received DEX and 12,274 (45.4%) did not. The DEX(+) cohort had fewer aggregate pulmonary complications (5.0 versus 8.3%, P < 0.001), was less likely to experience acute respiratory failure (3.6 versus 5.7%, P < 0.001), reintubation (0.6 versus 1.1%, P < 0.001), pneumonia (2.1 versus 4.2%, P < 0.001) or pulmonary edema (0.6 versus 1.1%, P < 0.001) compared to the DEX(-) cohort. After accounting for potential confounders, the DEX(+) cohort was at decreased risk of aggregate pulmonary complications (adjusted odds ratio [aOR]: 0.83, 95% confidence interval [CI]: 0.74 to 0.92, P = 0.001), pneumonia (aOR: 0.73, 95% CI: 0.63 to 0.85, P < 0.001) and pulmonary edema (aOR: 0.72, 95% CI: 0.54 to 0.96, P = 0.026) compared to the DEX(-) cohort. Perioperative DEX administration was associated with a significantly decreased risk of aggregate pulmonary complications, including pneumonia and pulmonary edema, following cemented THA. Orthopaedic surgeons utilizing cement fixation in THA should consider the utilization of perioperative DEX.