Risk of Infection in Thumb Carpometacarpal Surgery After Corticosteroid Injection

Abstract

Purpose The purpose of this study was to determine whether patients who had an intraarticular corticosteroid injection into the thumb carpometacarpal (CMC) joint for the treatment of arthritis within the 3 months before CMC joint arthroplasty or arthrodesis were at increased risk for wound complication/infection and/or repeat surgery for wound complication/infection in comparison with patients who did not receive an injection within 6 months or who received an injection between 3 and 6 months before surgery.Methods We identified 5,046 patients in the Humana claims database who underwent surgery for CMC joint arthritis. The patients were stratified into 3 groups: (1) no thumb injection within 6 months of CMC joint surgery, (2) thumb injection between 3 and 6 months before CMC joint surgery, and (3) thumb injection within 3 months before CMC joint surgery. The primary outcome was wound complication/infection within 90 days after surgery. The secondary outcome was repeat surgery for wound complication/infection within 90 days after surgery. Multivariable logistic regression was performed to assess the associations between the timing of injection and wound complication/infection and repeat surgery for wound complication/infection. ResultsThe rates of wound complication/infection within 90 days after surgery were similar among the 3 study groups. However, patients who received an intra-articular corticosteroid injection within 3 months before surgery had a 2.2 times greater likelihood of repeat surgery for a wound complication/infection compared with patients who did not have an injection within 6 months before surgery.Conclusions Patients who receive an intra-articular corticosteroid injection within the 3 months before surgery for CMC joint arthritis may be at increased risk of repeat surgery to treat a wound complication/infection in the 90-day postoperative period.

Readmission and Reoperation Following Carpometacarpal Arthroplasty

“…Finally, presurgical steroid injections have been shown to more than double the likelihood of postsurgical revision due to wound complications or infection. 29 Wound complications after CMC arthroplasty are relatively low, reported by Shah et al 13 to be 0.66%. This could account for the overall low rate of reoperation.…”

Hand and Upper Extremity Surgical Site Infection Rates Associated With Perioperative Corticosteroid Injection: A Review of the Literature

“…Different corticosteroids are available, each with specific solubilities to enhance their efficacy in different environments such as tendon sheath or intra-articular. In this review, 7 studies 6,7,13,17,18,21,25 reported the CSI type that surgeons used preoperatively or intraoperatively, most of which were triamcinolone, the least soluble injectable corticosteroid. 4 Insoluble steroid compounds require host hydrolase enzymes to release the active form of the drug; less soluble steroids have a longer half-life.…”

“…For example, preoperative CSI given before or within 3 months of the carpometacarpal (CMC) joint surgery showed increased postoperative infection rates in some studies but not in others. 13,14 A review on the temporal effect of perioperative CSI on postsurgical infection rates for procedures of the hand, wrist, elbow, and shoulder has not been published as far as we are aware. There is no consensus on time between preoperative CSI and surgery to reduce subsequent infection rates for many procedures, including shoulder arthroscopy.…”

What’s New in Hand and Wrist Surgery

“…As in other orthopaedic subspecialties, the correlation between surgical site infection and recent corticosteroid injection has been examined. The rate of surgical site infection or wound complications for CMC arthroplasty was significantly increased when a corticosteroid injection has been administered to the surgical site within 90 days prior to the surgical procedure 43 . Kirby et al demonstrated a much higher rate of infection after CTR if a corticosteroid injection had been administered preoperatively (mean, 55 days) 44 .…”