JOA - 2026-05-18 - Journal Article
Rates of New-Onset Postoperative Heart Failure Among Type 2 Diabetics Who Use Nonsteroidal Anti-Inflammatory Drugs for Total Hip Arthroplasty.
Antonioli SS, Saba BV, Schaffer O, Prinos A, Khury F, Schwarzkopf R, Macaulay W
Topics
Key Takeaway
T2DM patients undergoing THA who received celecoxib developed new-onset postoperative heart failure at nearly double the rate of those receiving meloxicam (7.1% vs. 4.0%, p=0.013).
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Summary
This study compared rates of new-onset postoperative heart failure in T2DM versus non-T2DM patients receiving perioperative meloxicam or celecoxib after primary elective THA, and then compared the two NSAIDs within the T2DM cohort using propensity matching for age, ASA score, and aspirin use. T2DM patients developed HF at more than twice the rate of non-diabetics (6.1% vs. 2.8%, p<0.001). Within T2DM patients, celecoxib was associated with significantly higher HF rates than meloxicam (7.1% vs. 4.0%, p=0.013).
Key Limitation
The study does not report NSAID dosing, duration of administration, or baseline echocardiographic data, making it impossible to determine whether the HF events were dose-dependent or occurred in patients with pre-existing subclinical cardiomyopathy.
Original Abstract
PURPOSE
Nonsteroidal anti-inflammatory drugs (NSAIDs) increase fluid retention and the risk of heart failure (HF). The NSAIDs are commonly used in total hip arthroplasty (THA) as part of a modern multimodal pain protocol, but the risk of selective cyclooxygenase-2 (COX-2)-preferential NSAIDs in THA for Type 2 diabetes mellitus (T2DM) patients, who have an increased risk for cardiac disease, is not well understood. This study aimed to compare rates of new-onset HF following THA in T2DM patients receiving perioperative meloxicam or celecoxib.
METHODS
A retrospective review was conducted of 18,142 patients who underwent primary elective THA. Data included demographics, perioperative aspirin, meloxicam and celecoxib use, T2DM diagnosis, and development of new-onset postoperative HF. Cohorts were separated based on the presence of a T2DM diagnosis and use of meloxicam or celecoxib. Propensity-matching controlled for age, American Society of Anesthesiologists score, and perioperative aspirin use. Rates of HF within T2DM patients who utilized peri-THA meloxicam versus celecoxib were compared.
RESULTS
Of patients who utilized meloxicam or celecoxib, T2DM patients experience new-onset postoperative HF at higher rates than non-diabetics (6.1 [T2DM] versus 2.8% [non-T2DM], P < 0.001). Within the T2DM patients, the patients who utilized celecoxib developed HF at higher rates than T2DM patients who utilized meloxicam (4.0 [meloxicam] versus 7.1% [celecoxib], P = 0.013).
CONCLUSIONS
Patients who have T2DM experience a higher incidence of new-onset postoperative HF compared to non-diabetics following perioperative selective NSAID use for THA. Additionally, T2DM patients developed HF at a greater rate when treated with perioperative celecoxib versus meloxicam. Given that both agents were associated with HF events in this high-risk population, caution is warranted when prescribing selective NSAIDs in T2DM patients undergoing THA. Risk-benefit considerations and individualized perioperative pain management strategies should be carefully considered.