The Effect of Intraoperative Corticosteroid Injections on the Risk of Surgical Site Infections for Hand Procedures

Lutsky, Kevin; Lucenti, Ludovico; Banner, Lauren; Matzon, Jonas L.; Beredjiklian, Pedro K.

doi:10.1016/j.jhsa.2019.07.004

Cited by 12 publications

(10 citation statements)

References 15 publications

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“…1 This study was performed based on a regional, large practice with 14 fellowship-trained orthopedic surgeons. 1 Postoperative infection was defined based on the CDC criteria for SSI. 1,5 Elbow as summarized in Table 2 7,20…”

Section: Intraoperativementioning

confidence: 99%

“…1 Postoperative infection was defined based on the CDC criteria for SSI. 1,5 Elbow as summarized in Table 2 7,20…”

Section: Intraoperativementioning

confidence: 99%

“…Corticosteroid injection (CSI) is a mainstay in orthopedic treatments due to its anti-inflammatory effects. 1 However, CSI has possible harms, including local infection, episodic hyperglycemia, hypopigmentation, tendon ruptures, fat atrophy, 1 and articular cartilage damage. 2 Corticosteroids treat trigger fingers first-line 3 and are therapeutic for De Quervain tenosynovitis.…”

Section: Introductionmentioning

confidence: 99%

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

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Pavlesen

Ablove

2023

Hand (New York, N,Y.)

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Background: Corticosteroid injection (CSI) has a relatively high benefit-to-risk ratio and is commonly administered to treat musculoskeletal conditions. However, perioperative CSI has been associated with an increased risk of postoperative infection. The literature suggests delaying surgery after CSI to minimize the risk of postoperative infection. We review the literature to summarize the most current knowledge on the association between perioperative CSI and infection rates for different hand and upper extremity procedures. Methods: Two independent reviewers conducted a literature search using PubMed and Web of Science databases (through October 1, 2022). The database searches used were (((injection) AND (infection)) AND (risk)) AND ((hand) OR (wrist) OR (elbow) OR (shoulder)). English-language articles were screened for infection rates associated with CSI given temporally around upper extremity surgery, focusing between 6 months preoperatively and 1 month postoperatively. Results: Nineteen articles including database queries and retrospective case-control or cohort studies were used after screening 465 articles. Most infection rates were increased in hand, wrist, elbow, and shoulder surgery between 3 months preoperatively and 1 month postoperatively. Intraoperative injection during elbow arthroscopy demonstrated increased infection rate relative to other upper extremity surgeries. Conclusions: Corticosteroid injection increased the risk of infection temporally around upper extremity surgeries; however, CSI provides benefits. The consensus regarding CSI timeline perioperatively has yet to be determined. The evidence supports an increased benefit-to-risk ratio when giving corticosteroids greater than 3 months preoperatively and greater than 1 month postoperatively for most upper extremity procedures, with relative contraindications within 1 month of upper extremity surgery.

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Section: Intraoperativementioning

confidence: 99%

“…1 Postoperative infection was defined based on the CDC criteria for SSI. 1,5 Elbow as summarized in Table 2 7,20…”

Section: Intraoperativementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

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Pavlesen

Ablove

2023

Hand (New York, N,Y.)

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“…7 In hand surgery, CSIs in the same hand but at a different site as a concomitant surgery have been shown to increase the risk of postoperative infection. 8 In addition, recent studies by Ng et al 9 and Matzon et al 10 indicate that preoperative CSIs are associated with an increased risk of infection after trigger finger release.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Corticosteroid Injections on Postoperative Infections in Trigger Finger Release

Kirby

Donnelly

Catalano

et al. 2021

Hand (New York, N,Y.)

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Background Corticosteroid injections have proven benefit in the treatment of symptomatic trigger finger; however, the immune system and tissue repair modulating properties of corticosteroids justify further consideration in surgical candidates. The aim of this study was to assess the relationship between corticosteroid injections and postoperative infection in trigger finger release. Methods A single-center retrospective review was conducted of patients seen from 2010 to 2019 to identify those who underwent trigger finger release with subsequent antibiotic prescription for chart-documented wound infection. A demographic matched cohort of 100 patients was identified for comparison. Preoperative corticosteroid injection history including timing, frequency, and dose was collected for all patients. Patient demographics, comorbidities, and presence of postoperative infection were collected from patient medical records. Superficial infection was defined as those requiring antibiotics for resolution without return to the operating room; deep infection was defined as infections that required irrigation and debridement. Results Of 3234 patients who underwent trigger finger release, 58 (1.8%) were identified with postoperative infections, 6 (0.2%) of which were deep infections. History of corticosteroid injection was significantly more common in patients with postoperative infection. Compared with an age-matched, gender-matched, and body mass index–matched cohort, patients with postoperative infection had significantly increased rate of diabetes mellitus at 34.5% to 19% ( P = .04) Conclusions While corticosteroid injection in the preoperative period is associated with a higher rate of postoperative infection, the time before surgery and the corticosteroid dose do not appear to have an effect.

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“…However, despite the documented short-term benefits, corticosteroid joint injections carry inherent risks and may lead to complications [ 3 ]. In some anatomical areas, preoperative corticosteroid injections have occasionally shown adverse postoperative effects [ 4 ]. For instance, injections administered before total knee and hip arthroplasty have been linked to an increased risk of postoperative infection [ 5 , 6 ]; other effects of corticosteroid injections are impaired wound healing, surgical site infection, tendon rupture, damage to the articular cartilage, attenuation of the subject’s immune response, skin hypopigmentation, fatty atrophy, and hyperglycemia [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Do Preoperative Corticosteroid Injections Increase the Risk of Infection after Shoulder Arthroscopy or Shoulder Arthroplasty? A Systematic Review

Lucenti,

Panvini,

de Cristo

et al. 2024

Healthcare

Self Cite

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Introduction: Corticosteroid injections have demonstrated short-term benefits for shoulder pain. This symptomatic treatment method is used in various inflammatory conditions that affect the shoulder joint. Corticosteroid joint injections are not without risks and complications. Adverse effects have been documented, including damage to the articular cartilage, tendon rupture, and attenuation of the subject’s immune response. The aim of this study was to examine the timing of preoperative corticosteroid injections on infectious outcomes of shoulder arthroscopies and shoulder arthroplasty. Materials and Methods: In accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the PubMed, Cochrane, and Science Direct databases were systematically reviewed by two independent authors in January 2024. After full-text reading and checking the reference lists, 11 article were included. Results: Patients who received a shoulder injection within three months prior to undergoing shoulder arthroplasty exhibited a markedly elevated incidence of infection. In addition, a significantly increased risk of periprosthetic joint infection (PJI) at 90 days postoperatively in patients who received CSIs (corticosteroid injections) within 1 month prior to shoulder arthroplasty was found. Different authors consider CSI injections within the 2 weeks prior to shoulder arthroscopy surgery principally associated with an increased risk of postoperative infection. Discussion: There is still no consensus on the correct timing of preoperative CSIs in both arthroscopic and arthroplasty procedures. The literature does not identify whether the number of preoperative injections could increase the risk of periprosthetic infection. Obesity, sex, and smoking did not have a significant effect on PJIs; alcohol abuse could be considered as a risk factor for PJIs with CSIs. Both in prosthetic surgeries and in arthroscopy procedures, modifiable and unmodifiable factors play secondary roles. The risk of postoperative infection is greater within 3 months, although it is almost comparable at one- and two-year follow-ups.

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The Effect of Intraoperative Corticosteroid Injections on the Risk of Surgical Site Infections for Hand Procedures

Cited by 12 publications

References 15 publications

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

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

The Effect of Corticosteroid Injections on Postoperative Infections in Trigger Finger Release

Do Preoperative Corticosteroid Injections Increase the Risk of Infection after Shoulder Arthroscopy or Shoulder Arthroplasty? A Systematic Review

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