title: Perioperative Dexamethasone Administration Does Not Increase the Incidence of Postoperative Infection in Total Hip and Knee Arthroplasty: A Retrospective Analysis.
abstract: Dexamethasone is frequently used for the treatment of postoperative nausea and vomiting and as an adjunct in multimodal postoperative analgesia after total joint arthroplasty; however, the incidence of periprosthetic joint infection (PJI) after the use of perioperative dexamethasone in total joint arthroplasty has yet to be fully elucidated.
  
  
  
  A retrospective chart review was conducted of all patients who underwent total hip or knee arthroplasty (N = 6294) between January 1, 2002 and January 31, 2014. The primary outcome was PJI requiring surgical intervention. Patients were subdivided into 2 cohorts; patients who received perioperative dexamethasone, a single 4- to 10-mg intravenous dose, as prophylaxis against postoperative nausea and vomiting (Dex group; N = 557) and those that did not receive perioperative dexamethasone (No Dex group; N = 5737). Secondary measures included timing of infection, culture data, and the type and number of subsequent procedures. Statistical analysis was performed using a chi-square or Fisher's exact test where appropriate.
  
  
  
  Seventy-four joints of the 6294 joints included in this analysis ultimately developed a PJI for an overall incidence of infection of 1.2%. Seven of the 557 joints (1.3%) in the Dex group developed a PJI; 67 of the 5737 joints (1.2%) in the No Dex group developed an infection. This difference was not significant (P = .8022). No significant difference in the timing of infection or the number of subsequent procedures was seen.
  
  
  
  A single intravenous perioperative dose of dexamethasone had no statistically significant difference in the rate of PJI after total hip or knee arthroplasty.
authors: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Andrew B
authors: AB
authors: Richardson
authors: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Abiram
authors: A
authors: Bala
authors: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Samuel S
authors: SS
authors: Wellman
authors: Department of Orthopaedic Surgery, Duke Orthopaedics at Page Road, Durham, North Carolina.
authors: David E
authors: DE
authors: Attarian
authors: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors: Michael P
authors: MP
authors: Bolognesi
authors: Department of Anaesthesiology, Duke University Medical Center, Durham, North Carolina.
authors: Stuart A
authors: SA
authors: Grant
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011184:Postoperative Period; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003907:Dexamethasone
keywords: anaesthesia; dexamethasone; periprosthetic infection; postoperative infection; retrospective