Impact of ongoing glucocorticoid use on postoperative complications following Total knee arthroplasty: a Japanese Nationwide propensity score-matched cohort study.

Abstract

Background: Glucocorticoid use poses perioperative concerns in orthopaedic surgery, but its impact on postoperative outcomes following total knee arthroplasty (TKA) remains unclear.

Methods: This retrospective cohort study utilized the Japanese Diagnosis Procedure Combination (DPC) database to examine postoperative complications in patients undergoing TKA between April 2016 and March 2023. Patients receiving continuous glucocorticoid therapy (≥5 mg/day prednisolone equivalent) were identified and matched 1:1 with non-glucocorticoid users using propensity score matching based on age, sex, body mass index, anaesthesia type, simultaneous bilateral surgery, and Charlson Comorbidity Index. Postoperative complications, including pneumonia, surgical site infection, venous thromboembolism, cerebrovascular events, and in-hospital mortality, were compared.

Results: A total of 12 212 patients (6 106 per group) were analysed after matching. The glucocorticoid group showed significantly higher incidences of pneumonia (OR: 3.70, 95% CI: 1.89-7.26, p = 0.0001) and in-hospital mortality (OR: 3.59, 95% CI: 1.47-8.73, p = 0.005). No significant differences were observed in the incidence of deep vein thrombosis, pulmonary embolism, or surgical site infection, possibly due to short in-hospital observation and widespread use of prophylactic protocols. Male sex also emerged as an independent risk factor for mortality.

Conclusions: Ongoing glucocorticoid use is associated with an increased risk of postoperative pneumonia and in-hospital mortality following TKA. These findings highlight the need for careful perioperative management in this high-risk population. Further prospective studies are warranted to assess long-term outcomes and clarify the effects of glucocorticoid dosage and duration.