Chronic Corticosteroid Use as a Risk Factor for Perioperative Complications in Patients Undergoing Total Joint Arthroplasty

Abstract

Background: Osteoarthritis may be caused by or concurrent with diseases such as rheumatoid arthritis or systemic lupus erythematosus, which rely on chronic corticosteroids regimens for treatment. If a total knee or hip arthroplasty is needed, this chronic treatment method has been associated with poorer surgical outcomes. Methods: A retrospective analysis of data collected by the American College of Surgeons National Surgical Quality Improvement Program was conducted. The Current Procedural Terminology codes were used to identify 403,566 total knee arthroplasty and total hip arthroplasty patients who were then stratified by the use of chronic corticosteroids for univariate analysis. Results: Forteen thousand seven hundred seventy-four of the patients identified were prescribed chronic corticosteroid regimens. A statistically significant difference was observed in perioperative complications for patients prescribed with corticosteroids, including higher rates of surgical site infection ( P = 0.0001), occurrence of deep incisional surgical site infection ( P < 0.0001), occurrences of organ space surgical site infection ( P < 0.0001), wound dehiscence ( P < 0.0001), general would infection ( P < 0.0001), pneumonia ( P < 0.0001), occurrences of unplanned intubation ( P = 0.0002), urinary tract infection ( P < 0.0001), and readmission ( P < 0.0001). No statistically significant difference was observed in the 30-day mortality between the 2 groups (0.63), venous thromboembolic event (0.42), cerebrovascular accident (0.12), myocardial infarction (0.49), cardiac arrest (0.098), deep vein thrombosis (0.17), or sepsis (0.52). Conclusion: Many of the notable differences in complications may be directly attributed to the immunosuppressive nature of corticosteroids. With increased knowledge of which perioperative complications to monitor, surgeons can tailor treatment strategies to this population that reduce morbidity and improve outcomes.

Perioperative management of patients with inflammatory rheumatic diseases

“…Recent larger studies [11][12][13][14] confirm data underlying previous recommendations [15,16] indicating a dose-dependent increased risk of perioperative complications, especially infections, with GCs. A retrospective study based on health insurance data from 10,923 RA patients undergoing elective knee or hip replacement showed that the risk of infections leading to hospitalization within 30 days postoperatively was significantly higher in patients receiving 5-10 mg prednisone equivalent/day (OR 1.32) and >10 mg/day (odds ratio [OR] 2.10) compared to patients not receiving GC therapy.…”

“…In a Danish registry-based cohort study, GC was also identified (in addition to increased disease activity) as a risk factor for mortality after knee/hip replacement (HR 2.87) [13]. In another Apremilast can be continued 5 9/10 9.7 The level of agreement (0 = no agreement, 10 = full agreement) is given as a mean value DMARD disease-modifying antirheumatic drugs, GC glucocorticoid, IL interleukin, JAK Janus kinase, LoE level of evidence according to the Oxford Centre for Evidence-Based Medicine [67], MTX methotrexate, TNF tumor necrosis factor retrospective analysis of 14,774 patients undergoing long-term GC therapy for various chronic conditions, significantly more perioperative complications, including wound infections, deep surgical infections, wound dehiscence, pneumonia, urinary tract infections, and re-hospitalization, were found in patients receiving GC compared with patients without GC according to a univariate analysis [14].…”

Prior Intra-articular Corticosteroid Injection Within 3 Months May Increase the Risk of Deep Infection in Subsequent Joint Arthroplasty: A Meta-analysis

“…Intra-articular corticosteroids do not dissolve quickly [26], and they may persist and lead to local immunosuppression after TJA. Patients with chronic corticosteroid use have a higher likelihood of surgical infection than corticosteroid-naïve patients; this increased likelihood may be caused by corticosteroid suppression of the proliferation of fibroblasts and an inhibition of the ability to remodel collagen [28]. Future studies will likely need to come from registries, national databases, or insurance company data.…”

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

“…It is necessary for doctors and nurses to strengthen preoperative assessment. Before surgery, it is necessary to understand the patient’s past medical history, general condition and blood coagulation, strengthen the screening of high-risk patients with DVT, and actively correct the effects of anemia, hypertension, diabetes and other cardiovascular diseases[ 40 ]. During the operation, the doctor should be familiar with the anatomy and surgical techniques, and reduce the operation and anesthesia duration.…”