Corticosteroid Injections Increase the Risk of Infection for Subsequent Trigger Finger Release Surgery
Cory Lebowitz, DO, Rowan University School of Osteopathic Medicine, Stratford, NJ, Jonas Matzon, MD, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, Pedro K Beredjiklian, MD, Rothman Institute, Philadelphia, PA, Kevin F Lutsky, MD, The Rothman Institute, Philadelphia, PA, Jack Graham, MD, Thomas Jefferson University, Philadelphia, PA and Ludovico Lucenti, MD, Vittorio Emanuele Hospital, Catania, Italy
INTRODUCTION: The effect of corticosteroid injections (CSIs) on subsequent trigger finger release surgery is poorly understood. We hypothesized that CSIs increase the risk of infection and the risk is time-dependent with injections closer to surgery carrying greater risk.
METHODS: We retrospectively evaluated patients undergoing trigger finger release over a 2-year period. We collected demographic information, medical comorbidities, trigger finger(s) operated on, presence of a prior CSI, date of most recent CSI, post-operative signs of infection, and need for surgery due to deep infection. Superficial infection was defined per the Centers for Disease Control criteria. Deep infection was defined as the need for surgery related to a surgical site infection.
RESULTS: Of 2480 fingers undergoing trigger release, 2.1% developed an infection - 1.7% superficial/0.5% deep. Prior to surgery, 1137 fingers had no CSI (1.5% superficial infection/0.1% deep infection) while 1343 had a CSI (1.8% superficial infection/0.8% deep infection). This difference in deep infection rate was significant with an odds ratio of 9.38 (p =0.03). Time from CSI to surgery was significantly shorter for fingers that developed a deep infection (82 days) compared to fingers that developed a superficial infection (194 days) (p =0.03). The odds ratio of developing a deep infection in patients who were operated on within 90 days (8 infections in 395 fingers) of an injection was 6.51 (95% CI 1.71-24.67) compared to patients who were operated on greater than 90 days after injection (3 infections in 948 fingers) (p = 0.006).
DISCUSSION and CONCLUSIONS: Preoperative CSIs substantially increase the rate of deep infection following trigger finger release surgery. The risk of deep postoperative infection after CSI seems to be time dependent with closer proximity between injection and trigger finger release having higher risk of infection. We recommend avoiding trigger finger release surgery within 90 days of a CSI.
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