Do Therapeutic Steroid Injections Increase Post-Operative Complications in Carpal Tunnel Release?
Omolola Priscilla Fakunle, BS1; Kevin Xavier Farley, BS2; Emily L DeMaio, BS1; Charles Daly, MD3
1Emory University School of Medicine, Atlanta, GA; 2Emory University, Atlanta, GA; 3Department of Orthopedics, Emory University, Atlanta, GA
It is whether preoperative therapeutic, corticosteroid injections for relief of carpel tunnel syndrome (CTS) increase the risk of postoperative complications after subsequent carpel tunnel release (CTR). The purpose of this study was to examine the association between preoperative injections and postoperative rates of surgical site infections (SSI) and wound complications following CTR. We hypothesized there would be no association between preoperative injections and subsequent complications.
Data was collected from the Truven MarketScan® database from 2010-2016 for all patients undergoing CTR. Preoperative injections were identified at multiple time points. Logistic regression was performed to assess the contribution of a preoperative injection on rates of 90-day complications, while controlling for patient demographic and comorbid data. CPT laterality modifiers were used to confirm preoperative injections at the site of surgery.
Overall, 160,307 patients underwent CTR during the study period. Of these, 13,018 (8.1%) had a preoperative injection in the 180 days preceding surgery on their ipsilateral limb. The sex distribution of the analyzed cohort was 67% female and 33% male, spanning less than 45 years old to greater than 65 years old. On both univariate and multivariate analysis, there was an increased risk of SSI with corticosteroid injections (p=0.04 and p=0.01, respectively); however, the total number of preoperative injections did not correlate with elevated SSI risk (p=0.971). This was not exhibited for revisions or wound complications (p=0.28 and p=0.99 versus p=0.28 and p=0.10, respectively).
DISCUSSION AND CONCLUSION:
Our study suggests that there is an increased risk of SSI when corticosteroid injections are administered in the 30 day period prior to surgery; however, there is no major difference in wound complications or revision rates. Given that corticosteroids are a cornerstone of conservative management, we are not advising against their use. Instead, we are encouraging surgeons to avoid offering them to patient in the immediate 30 day preoperative period as well as counseling on their associated risks and benefits at all preoperative timepoints.
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