Werner Brian C, Cancienne Jourdan M, Burrus M Tyrrell, Park Joseph S, Perumal Venkat, Cooper M Truitt
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A..
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
Arthroscopy. 2016 Feb;32(2):350-4. doi: 10.1016/j.arthro.2015.07.029. Epub 2015 Oct 1.
To employ a national database to evaluate the association between intraoperative corticosteroid injection at the time of ankle arthroscopy and postoperative infection rates in Medicare patients.
A national insurance database was queried for Medicare patients who underwent ankle arthroscopy, including arthroscopic removal of loose body, synovectomy, and limited or extensive debridement. Two groups were created: ankle arthroscopy with concomitant local steroid injection (n = 459) and a control group of patients who underwent ankle arthroscopy without intraoperative local steroid injection (n = 9,327). The demographics and Charlson Comorbidity Index of each group were compared. Infection rates within 6 months postoperatively were assessed using International Classification of Diseases, 9th revision, and Current Procedural Terminology codes and compared between groups using χ(2)-tests.
A total of 9,786 unique patients who underwent ankle arthroscopy were included in the study. There were no statistically significant differences between the steroid injection study group and controls for the assessed infection-related variables, including gender, age group, obesity, smoking, and average Charlson Comorbidity Index. The infection rate for patients who had a local steroid injection at the time of surgery was 3.9% (18/459 patients), compared with 1.8% (168/9,327 patients) in the control group (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.7; P = .002.) The majority of this difference was noted between the 65 and 79 years age groups.
The use of intraoperative intraarticular corticosteroid injection at the time of ankle arthroscopy in Medicare patients is associated with significantly increased rates of postoperative infection compared with controls without intraoperative steroid injections.
利用国家数据库评估医疗保险患者踝关节镜检查时术中注射皮质类固醇与术后感染率之间的关联。
查询国家保险数据库中接受踝关节镜检查的医疗保险患者，包括关节镜下取出游离体、滑膜切除术以及有限或广泛清创术。创建两组：踝关节镜检查同时进行局部类固醇注射组（n = 459）和未在术中进行局部类固醇注射的踝关节镜检查患者对照组（n = 9327）。比较两组的人口统计学特征和查尔森合并症指数。使用国际疾病分类第9版和当前程序术语编码评估术后6个月内的感染率，并使用χ²检验比较两组之间的感染率。
本研究共纳入9786例接受踝关节镜检查的患者。在类固醇注射研究组和对照组之间，评估的与感染相关的变量，包括性别、年龄组、肥胖、吸烟和平均查尔森合并症指数，均无统计学显著差异。手术时接受局部类固醇注射的患者感染率为3.9%（18/459例患者），而对照组为1.8%（168/9327例患者）（优势比为2.2；95%置信区间为1.4至3.7；P = .002）。这种差异主要在65至79岁年龄组中观察到。
与未在术中注射类固醇的对照组相比，医疗保险患者踝关节镜检查时使用术中关节内注射皮质类固醇与术后感染率显著增加相关。
