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American Association for Hand Surgery

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Steroid Injection Quantity and Risk of Surgical Trigger Finger Release: A Dose-Response Relationship
Samantha Maasarani, M.D., M.P.H.1, Sarah A. Layon, B.S.2, Corinne Wee, M.D.1, Syed I Khalid, MD3 and Shelley S. Noland, MD4, (1)Cleveland Clinic, Cleveland, OH, (2)University of Minnesota Medical School, Minneapolis, MN, (3)Rush University Medical Center, Chicago, IL, (4)Department of Orthopaedics and Sports Medicine, Mayo Clinic, Phoenix, AZ

HYPOTHESIS
This study compares the rates and risk of conversion to surgical release in patients with trigger finger treated by one, two, or three or more steroid injections.

METHODS
PearlDiver's all-payor claims database, Mariner-30, was queried to identify patients diagnosed with trigger finger between 2010 and 2019. Multivariate logistic regression models were created, and significant variables were utilized as match criterion to mitigate potential confounding factors. One-to-one exact matching was used to stratify trigger finger patients into 4 identical groups: 1) patients not receiving steroid injections, 2) those treated with one steroid injection, 3) those treated with two steroid injections, and 4) those treated with three or more steroid injections. The primary aim of this study was to assess the rate and risk of conversion to subsequent surgical release within 5-years.

RESULTS
The matched population analyzed in this study consisted of 146,932 patients with trigger finger that were equally represented in 4 cohorts: no steroid injections (n=36,733, 25.00%), one steroid injection (n=36,733, 25.00%), two steroid injections (n=36,733, 25.00%), and three or more steroid injections (n=36,733, 25.00%). A total of 40,591 patients underwent surgical release within our 5-year follow-up period. Rates of surgical release were highest in the three or more steroid injection (n=13,598, 37.02%) and lowest in the no steroid injection (n=7,339, 19.98%) cohorts (p<0.0005). Cox proportional hazard models revealed a dose-response relationship with the risk of conversion to surgical release increasing from the one injection cohort (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.90-0.98), no injection cohort (HR 0.96, 95% CI 0.92-0.99), two injections (HR 1.08, 95% CI 1.05-1.12), and three or more injections (HR 1.44, 95% CI 1.39-1.48).

CONCLUSION
Patients with trigger finger treated with a single steroid injection had the lowest rate and risk of conversion to surgical release compared to those not receiving steroids and those receiving two or more injections. Furthermore, the rates and risk of undergoing surgical release follows a dose-response relationship as the number of steroid injections increases.

Figure 1. Cox-Proportional Hazard Plot
Figure 2. Box Plot


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