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Corticosteroid injection prior to carpal tunnel release increased infection risk
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LAS VEGAS — Patients who received a corticosteroid injection within 1 year preoperatively of carpal tunnel release had an increased risk of surgical site infection, according to results presented here.
“We, at least at this point, cannot say with any certainty that there is a specific recommendation of how long you should wait after your injection before surgery,” Benjamin L. Gray, MD, MSCE, said in his presentation at the American Society for Surgery of the Hand Annual Meeting.
Using the Optum database, Gray and colleagues identified 234,000 patients who underwent carpal tunnel release. Of these patients, 17,000 patients had a corticosteroid injection within 1 year of surgery and 96,000 patients did not have an injection.
“The primary outcome was serious infections that required return to the operating room within 3 months of surgery,” Gray said.
Gray noted patients in the injection group had higher preoperative rates of peripheral vascular disease, depression, liver disease and rheumatoid arthritis. Patients who underwent injection prior to carpal tunnel release had increased odds of requiring surgical debridement, according to results of a univariate analysis, and a higher risk of this outcome found among patients with peripheral vascular disease, congestive heart failure and depression. Similarly, results of a multivariable analysis showed patients who received injection prior to carpal tunnel release had a significantly greater risk of infection.
When the cohorts were matched based on propensity score, Gray noted a 14% increased risk of infection among patients who received injection. Patients with known laterality also had a higher risk of infection, according to results of a sensitivity analysis.
“Lastly, we tried to look at the timing of injections. How long before surgery did they receive their injection?” Gray said. “So, we used Cox regression analysis and we found there was an increased risk [of infection] for injections that were given within 3 months of surgery. We also saw there was an increase between 6 and 9 months, as well.” – by Casey Tingle
Reference:
Gray BL, et al. Abstract 15. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 5-7, 2019; Las Vegas.
Disclosure: Gray reports he receives research support from Polyganics and is a paid consultant for Synthes.