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The Needle and the Knife: Distant Site Corticosteroid Injections Are Not Associated with Surgical Site Infection After Soft Tissue Hand Surgery
Thompson Zhuang, MD MBA, Ellis Berns, MD, Mitchell J Hallman, MD; Hannah Hoeun Lee, MD, PhD
University of Pennsylvania, Philadelphia, PA
Introduction: Intra-articular corticosteroids are commonly used in the treatment of knee, hip, and shoulder osteoarthritis, but can have systemic immunosuppressive effects such as increased infection risk. However, it is unknown whether preoperative distant site steroid injection(s) increase the risk of surgical site infection after hand surgery.
In this study, we tested the null hypothesis that distant site intra-articular corticosteroid injection prior to hand surgery is not associated with surgical site infection, reoperation for infection, or wound dehiscence.
Methods: Using a national administrative claims database, we identified adult patients undergoing carpal tunnel, trigger finger, or DeQuervain release. Patients were divided into four cohorts: intra-articular corticosteroid injection between 0-30, 31-60, or 61-90 days before surgery or no injection within 90 days prior to surgery. Large and intermediate joints were considered. We measured surgical site infection incidence, reoperation, and wound dehiscence within 90 days postoperatively. We created multivariable logistic regression models to evaluate the association between preoperative corticosteroid injection and each outcome, adjusting for age, sex, region, insurance plan, Elixhauser comorbidities, and history of tobacco use. Statistical significance was defined as p<0.0167 after adjustment for multiple comparisons.
Results: Receiving a large-joint corticosteroid injection between 0-30, 31-60, or 61-90 days before surgery was not associated with surgical site infection or reoperation. Receiving a large-joint corticosteroid injection between 0-30 days before surgery was associated with a slightly higher incidence of wound dehiscence compared to no injection (0.5% vs. 0.4%). Receiving an intermediate-joint corticosteroid injection between 0-30, 31-60, or 61-90 days before surgery was not associated with the incidence of surgical site infection, reoperation, or wound dehiscence. In patients with diabetes, receiving a corticosteroid injection within 90 days before surgery in a large or intermediate joint was not associated with an increased risk of surgical site infection, reoperation, or wound dehiscence.
Conclusions: Corticosteroid injections into large- and intermediate-sized joints can be safely administered before hand surgery from a surgical site infection perspective, including in patients with diabetes.
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