Intraoperative vasopressor use as a risk factor for early periprosthetic joint infection after total joint arthroplasty: A retrospective cohort study.

Abstract

Periprosthetic joint infection (PJI) is a serious complication following total joint arthroplasty (TJA), but intraoperative vasopressor use has not been previously evaluated as a risk factor. This study investigates whether the number of vasopressors administered intraoperatively is a risk factor for early PJI in TJA. We retrospectively reviewed 1286 patients who underwent primary TJA (896 TKAs and 390 THAs) at our institution from 2020 to 2025. Patients were stratified into three groups according to the number of vasopressors administered intraoperatively: 0, 1, or ≥2. Demographics, comorbidities, procedure type, anesthesia type, and intraoperative hypotension (minutes with MAP <65 mmHg, MIN65) were compared between groups. Multivariable logistic regression was used to identify independent predictors of PJI within 90 days. 494 patients (38.4%) received no vasopressors intraoperatively, 557 (43.3%) received one vasopressor, and 235 (18.3%) received 2 or more. 9 patients (0.7%) had a PJI within 90 days. 30 and 90-day all-cause readmission rates were not significantly different regardless of vasopressor use. Receiving ≥2 vasopressors was an independent predictor of increased PJI risk (OR 17.2, 95% CI 2.18-369.0, p = 0.017), as was increased American Society of Anesthesiologists class (ASA) (OR 13.80, 95% CI 2.2-87.10, p = 0.0049) while regional spinal anesthesia was independently protective (OR 0.136, 95% CI: 0.03-0.56, <i>p</i> = 0.0059). In this study, use of ≥2 vasopressors intraoperatively was independently associated with an increased risk of PJI within 90 days, which may represent refractory intraoperative hypotension or physiological stress. This novel finding indicates that further research with larger cohort sizes is warranted, and these findings should be interpreted with caution and be considered exploratory.