Does vasopressor administration in the ICU affect outcomes following primary total joint arthroplasty?

Introduction

The subset of patients admitted to the intensive care unit (ICU) following total joint arthroplasty (TJA) has yet to be studied in detail. Specifically, there is little data on the effects of vasopressor administration in patients who require critical care after TJA. We sought to characterize patient outcomes and mortality by vasopressor administration in the ICU following primary TJA.

Methods

We retrospectively reviewed 187 patients who required admission to the ICU within 14 days following primary, unilateral TJA from 2012 to 2024, out of 47,083 patients who underwent TJA during this time (0.40%). Exclusion criteria included TJA for trauma, acute fracture, and revision or conversion TJA. Patients were classified by whether they received any vasopressor (i.e., norepinephrine, phenylephrine, or vasopressin) medication at any point during their ICU stay. Limited intraoperative use of vasopressor did not qualify. Demographic and surgical data were collected and compared. Primary outcomes included complications, revisions/reoperations.

Results

Of the 187 patients requiring ICU admission following primary TJA, 20 received vasopressors during their stay. No significant demographic differences were found between cohorts. Hypotension (26%) was the most common indication for ICU admission. Vasopressor use was not associated with a significant increase in 30-day or one-year mortality (5.0 vs. 0.6%, P=0.07; 5.0 vs. 1.2%, P=0.20, respectively), but was associated with a significant increase in revisions/reoperations 25.0 vs 6.0%, P=0.005). No significant differences were observed for 90-day VTE events (P=0.62). Dislocations were significantly more common in patients who received vasopressors (14.3 vs. 1.0%, P=0.047).

Conclusion

Patients who received vasopressors in the ICU following TJA had significantly higher rates of revisions, reoperations, and dislocation. There were no differences in mortality rates or VTE rates between groups. Further investigation is required to better characterize outcomes following vasopressor requirement in the total joint arthroplasty population.