Intraoperative dexamethasone can reduce postoperative pain and nausea following total knee (TKA) and total hip arthroplasty (THA). To the best of our knowledge, no study to date has been adequately powered to detect the risk of periprosthetic joint infection (PJI) from early dexamethasone exposure. This study aimed to assess PJI rates and complications in patients undergoing primary elective TKA and THA who received intraoperative dexamethasone. A national database was used to identify adults undergoing primary elective TKA and THA between 2015 and 2020. Patients who received intraoperative dexamethasone and those who did not were identified. The primary endpoint was 90-day risk of infectious complications. Secondary end points included thromboembolic, pulmonary, renal, and wound complications. Multivariate analyses were performed to assess the risk of all endpoints between cohorts. Between 2015 and 2020, 1,322,025 patients underwent primary elective TJA, of which 857,496 (64.1%) underwent TKA and 474,707 (35.9%) underwent TKA. In patients who underwent TKA, dexamethasone was associated with lower risk of PJI (adjusted odds ratio: 0.87, 95% CI: 0.82-0.93, < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, and acute kidney injury. In patients who underwent THA, dexamethasone was associated with a lower risk of PJI (adjusted odds ratio: 0.80, 95% CI: 0.73-0.86, < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, acute kidney injury, and pneumonia. Intraoperative dexamethasone was not associated with increased risk of infectious complications. The data presented here provide evidence in support of intraoperative dexamethasone utilization during primary TKA or THA.

中文翻译：

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术中使用地塞米松是否与全关节置换术后假体周围关节感染率增加有关？

术中地塞米松可以减轻全膝关节置换术（TKA）和全髋关节置换术（THA）术后的疼痛和恶心。据我们所知，迄今为止还没有足够的研究能够检测早期接触地塞米松导致假体周围关节感染 (PJI) 的风险。本研究旨在评估术中接受地塞米松的初次择期 TKA 和 THA 患者的 PJI 发生率和并发症。使用国家数据库来确定 2015 年至 2020 年间接受初次选择性 TKA 和 THA 的成人。确定了术中接受和未接受地塞米松的患者。主要终点是 90 天感染并发症的风险。次要终点包括血栓栓塞、肺部、肾脏和伤口并发症。进行多变量分析以评估队列之间所有终点的风险。 2015年至2020年间，共有1,322,025例患者接受了初次择期TJA，其中857,496例（64.1%）接受了TKA，474,707例（35.9%）接受了TKA。在接受 TKA 的患者中，地塞米松与较低的 PJI 风险相关（调整后比值比：0.87，95% CI：0.82-0.93，< .001）以及其他次要终点，如肺栓塞、深静脉血栓形成和急性血栓形成肾损伤。在接受 THA 的患者中，地塞米松与较低的 PJI 风险相关（调整后比值比：0.80，95% CI：0.73-0.86，< .001）以及其他次要终点，如肺栓塞、深静脉血栓形成、急性肾损伤、肺炎。术中地塞米松与感染并发症风险增加无关。这里提供的数据提供了支持初次 TKA 或 THA 术中使用地塞米松的证据。