Dexamethasone is Associated with a Dose-Dependent Reduction in Venous Thromboembolic Complications following Total Knee and Hip Arthroplasty.

Abstract

Venous thromboembolism (VTE) following total knee (TKA) and hip (THA) may be mediated by postoperative inflammatory dysregulation. Emerging literature has suggested that perioperative dexamethasone may reduce the risk of VTE by mitigating inflammation-driven thrombogenesis. The present study sought to compare postoperative VTE complications across patients receiving varying perioperative dexamethasone doses. Using a national healthcare database that captures approximately 25% of inpatient procedures in the United States, we identified adult patients undergoing primary TKA and THA between 2016 and 2023. Patients who received dexamethasone on the day of surgery were identified and stratified into either a no dexamethasone, low-dose (less than eight milligrams [mg]), medium-dose (eight to 12 mg), or high-dose (greater than 16 mg) cohort. Outcomes were compared between the cohorts utilizing mixed-effects logistic regression. The primary outcome was the 90-day adjusted odds of VTE complications. Among TKA patients (n = 946,019), 393,971 (41.7%) did not receive dexamethasone, 161,287 (17.1%) received low-dose, 310,595 (32.8%) received medium-dose, and 80,166 (8.5%) received high-dose. Among THA patients (n = 537,684), 239,671 (44.6%) did not receive dexamethasone, 80,166 (14.9%) received low-dose, 151,875 (28.3%) received medium-dose, and 66,482 (12.4%) received high-dose. Within the TKA cohort, all dosing groups had significantly lower adjusted odds of VTE compared to the unexposed patients (low dose - adjusted odds ratio [aOR]: 0.93, 95% confidence interval [CI]: 0.87 to 0.99, P = 0.020; medium dose - aOR: 0.84, 95% CI: 0.80 to 0.89, P < 0.001; high dose - aOR: 0.79, 95% CI: 0.72 to 0.88, P < 0.001) when compared to those who did not receive dexamethasone. For THA patients, the adjusted odds of VTE were significantly lower in just the medium (aOR: 0.85, 95% CI: 0.77 to 0.94, P = 0.001) and high dose (aOR: 0.78, 95% CI: 0.64 to 0.94, P = 0.009) groups. Patients who received higher doses of dexamethasone experienced lower rates of VTE complications. Arthroplasty surgeons should consider higher doses of dexamethasone as a perioperative adjunct to standard VTE chemoprophylaxis regimens.