Among patients with type 2 diabetes undergoing total hip arthroplasty, perioperative celecoxib use was associated with a higher rate of new-onset heart failure than meloxicam (7.1% vs 4.0%, P=0.013).
Cohort (n=18,142)
Does perioperative celecoxib compared to meloxicam increase the risk of new-onset postoperative heart failure in patients with type 2 diabetes mellitus undergoing total hip arthroplasty?
In patients with type 2 diabetes undergoing total hip arthroplasty, perioperative use of celecoxib is associated with a significantly higher rate of new-onset postoperative heart failure compared to meloxicam.
Absolute Event Rate: 7.1% vs 4%
p-value: p=0.013
BACKGROUND: 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-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 nondiabetics (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 than nondiabetics 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.
Antonioli et al. (Fri,) conducted a cohort in Type 2 diabetes mellitus undergoing total hip arthroplasty (n=18,142). Celecoxib vs. Meloxicam was evaluated on New-onset postoperative heart failure (p=0.013). Among patients with type 2 diabetes undergoing total hip arthroplasty, perioperative celecoxib use was associated with a higher rate of new-onset heart failure than meloxicam (7.1% vs 4.0%, P=0.013).