Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Am J Sports Med. 2019 Mar;47(4):915-921. doi: 10.1177/0363546518825348. Epub 2019 Feb 13.
Corticosteroid injections are sometimes used in the postoperative period after shoulder arthroscopy; however, a well-defined safety profile has not been established.
To examine the association between the timing of postoperative corticosteroid injections and rates of infection after shoulder arthroscopy.
Cohort study; Level of evidence, 3.
Private payer and Medicare national insurance databases were queried for patients who underwent arthroscopic rotator cuff repair, debridement, or subacromial decompression. Patients who underwent corticosteroid injections within 1, 2, 3, or 4 months postoperatively were identified and compared with a matched control group that underwent the same procedures without a postoperative steroid injection. International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes were used to identify rates of postoperative infection within 90 days after injection for the study groups and controls. Multivariate binomial logistic regression analysis was used to compare groups, and adjusted odds ratios (ORs) and 95% CIs were calculated, with P < .05 considered significant.
A total of 3946 patients were identified, including 264 patients who received an injection within 1 month after surgery, 471 within 2 months, 1037 within 3 months, 1874 within 4 months, and 2640 matched controls. When compared with controls, patients who underwent a corticosteroid injection within 1 month postoperatively had a significantly higher rate of infection (private payer: OR, 2.63; P = .014; Medicare: OR, 11.2; P < .0001). There were no differences in infection rates at all other time points ( P = .264-.835).
This study adds to the evidence suggesting caution when administering injections in the immediate postoperative period after shoulder arthroscopy. Although causality cannot be determined on the basis of this database review, the authors found a significant association between intra-articular corticosteroid injections administered 1 month postoperatively and an increased rate of postoperative infection in Medicare and private payer patient cohorts as compared with a control group.
皮质类固醇注射有时用于肩关节镜检查后的术后期间；然而，尚未确定明确的安全性概况。
检查肩关节镜检查后皮质类固醇注射时机与感染率之间的关系。
队列研究；证据水平，3 级。
私人支付者和医疗保险国家保险数据库被查询了接受关节镜下肩袖修复、清创或肩峰下减压术的患者。确定术后 1、2、3 或 4 个月内接受皮质类固醇注射的患者，并将其与接受相同手术但术后未接受皮质类固醇注射的匹配对照组进行比较。国际疾病分类，第九修订版和当前程序术语代码用于识别研究组和对照组注射后 90 天内的术后感染率。使用多变量二项式逻辑回归分析比较组，计算调整后的优势比（OR）和 95%置信区间（CI），P <.05 为差异有统计学意义。
共确定了 3946 名患者，其中 264 名患者在手术后 1 个月内接受了注射，471 名在 2 个月内，1037 名在 3 个月内，1874 名在 4 个月内，2640 名匹配对照组。与对照组相比，术后 1 个月内接受皮质类固醇注射的患者感染率显著更高（私人支付者：OR，2.63；P =.014；医疗保险：OR，11.2；P <.0001）。在所有其他时间点，感染率均无差异（P =.264-.835）。
本研究增加了证据，表明在肩关节镜检查后立即进行注射时应谨慎。尽管基于本数据库回顾不能确定因果关系，但作者发现，与对照组相比，在医疗保险和私人支付者患者队列中，术后 1 个月内关节内皮质类固醇注射与术后感染率增加显著相关。
