Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, U.S.A.
Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, U.S.A.
Arthroscopy. 2024 Feb;40(2):277-283.e1. doi: 10.1016/j.arthro.2023.08.073. Epub 2023 Sep 7.
To refine the understanding of the effect of timing of corticosteroid injections (CSIs) and shoulder arthroscopy on postoperative infection.
An insurance database was used to determine all patients who underwent shoulder arthroscopy for a 5-year period with an associated preoperative ipsilateral corticosteroid injection. Patients were stratified into cohorts based on timing of preoperative CSI: (1) 0-<2 weeks, (2) 2-<4 weeks, (3) 4-<6 weeks, and (4) 6-<8 weeks. Patients were pooled to include all patients who had a CSI less than 4 weeks and those longer than 4 weeks. A cohort of patients who never had a corticosteroid injection before undergoing arthroscopy were used as a control. All patients had a follow-up of 2 years. Multivariable regression analyses were performed using R Studio with significance defined as P < .05.
Multivariate logistic regression showed a greater odds ratio (OR) for postoperative infection in patients who received CSI 0-<2 weeks before shoulder arthroscopy at 90 days (3.10, 95% confidence interval [CI] 1.62-5.57, P < .001), 1 year (2.51, 95% CI 1.46-4.12, P < .001), and 2 years (2.08, 95% CI 1.27-3.28, P = .002) compared with the control group. Patients who received CSI 2-<4 weeks before shoulder arthroscopy had greater OR for infection at 90 days (2.26, 95% CI 1.28-3.83, P = .03), 1 year (1.82, 95% CI 1.13-2,82, P = .01), and 2 years (1.62, 95% CI 1.10-2.47, P = .012). Patients who received CSI after 4 weeks had similar ORs of infection at 90 days (OR 1.15, 95% CI 0.78-1.69, P = .48) 1 year (OR 1.18, 95% CI 0.85-1.63 P = .33), and 2 years (OR 1.09, 95% CI 0.83-1.42, P = .54), compared with the control cohort.
The present study shows the postoperative infection risk is greatest when CSIs are given within 2 weeks of shoulder arthroscopy, whereas CSIs given within 2-<4 weeks also portend increased risk, albeit to a lesser degree. The risk of postoperative infection is not significantly increased when CSIs are given more than 1 month before surgery.
Level III, retrospective comparative, prognosis study.
深入了解皮质类固醇注射（CSIs）和肩关节镜检查对术后感染的影响。
使用保险数据库确定了 5 年内接受同侧术前皮质类固醇注射的所有接受肩关节镜检查的患者。根据术前 CSI 的时间将患者分层为队列：（1）0-<2 周，（2）2-<4 周，（3）4-<6 周，和（4）6-<8 周。将所有接受小于 4 周和大于 4 周 CSI 的患者合并为一个队列。从未接受过皮质类固醇注射的患者作为对照。所有患者的随访时间均为 2 年。使用 R Studio 进行多变量逻辑回归分析，定义 P <.05 为具有统计学意义。
多变量逻辑回归显示，在接受 CSI 0-<2 周的患者中，在术后 90 天（优势比[OR] 3.10，95%置信区间[CI] 1.62-5.57，P <.001）、1 年（OR 2.51，95% CI 1.46-4.12，P <.001）和 2 年（OR 2.08，95% CI 1.27-3.28，P =.002）时，发生术后感染的可能性更大，与对照组相比。在接受 CSI 2-<4 周的患者中，在术后 90 天（OR 2.26，95% CI 1.28-3.83，P =.03）、1 年（OR 1.82，95% CI 1.13-2.82，P =.01）和 2 年（OR 1.62，95% CI 1.10-2.47，P =.012）时，发生感染的可能性更大。接受 CSI 超过 4 周的患者在术后 90 天（OR 1.15，95% CI 0.78-1.69，P =.48）、1 年（OR 1.18，95% CI 0.85-1.63，P =.33）和 2 年（OR 1.09，95% CI 0.83-1.42，P =.54）时，发生感染的可能性与对照组相似。
本研究表明，CSI 在肩关节镜检查前 2 周内进行时，术后感染风险最高，而 CSI 在 2-<4 周内进行时，感染风险也增加，尽管程度较轻。CSI 在手术前 1 个月以上进行时，术后感染的风险不会显著增加。
III 级，回顾性比较，预后研究。
