Khabyeh-Hasbani Nathan, Yan Yufan, Cohen Joshua M, Abuqubo Rami Z, Koehler Steven M
Montefiore Einstein, Bronx, NY, USA.
Hand (N Y). 2024 Nov 29:15589447241300713. doi: 10.1177/15589447241300713.
The recent trend in administering postoperative oral corticosteroids has proven effective in alleviating pain and improving surgical outcomes for hand and upper extremity procedures. However, concerns persist regarding potential infection risks despite a lack of supporting evidence in the current literature. We propose that a 6-day regimen of low-dose postoperative oral corticosteroids is safe and does not increase the likelihood of surgical site infections (SSIs) in adult upper extremity surgeries.
A retrospective study of all adult patients who underwent clean, upper extremity surgery, including both soft tissue and hardware implantation cases, between November 2021 and November 2023, performed at a single institution were included in the study. Primary outcome measures were diagnosis of SSI by 14 days and 30 days. Categorical variables were compared using χ tests, and continuous variables were compared using Wilcoxon rank-sum tests. A value less than .05 was considered statistically significant.
A total of 813 cases were included for analysis-196 received a 6-day course of postoperative oral steroids (methylprednisolone) and 617 did not. Both groups had similar SSI rates of 4.1% and 3.1%, respectively, with no statistical differences between the groups at any postoperative time. Subgroup analysis of patients diagnosed with an SSI identified no statistically different demographic factors or medical comorbidities when comparing patients who received postoperative oral corticosteroids versus those who did not.
Low-dose, postoperative oral steroid use following adult upper extremity surgery is safe and does not increase the risk of SSI. Further investigations with prospective studies on postoperative oral corticosteroids would prove advantageous.
近期术后口服皮质类固醇的应用趋势已被证明在减轻手部和上肢手术的疼痛及改善手术效果方面有效。然而，尽管目前文献中缺乏支持证据，但对于潜在感染风险的担忧依然存在。我们提出，术后口服低剂量皮质类固醇6天的方案是安全的，并且不会增加成人上肢手术手术部位感染（SSI）的可能性。
对2021年11月至2023年11月在单一机构进行的所有接受清洁上肢手术的成年患者进行回顾性研究，包括软组织和硬件植入病例。主要结局指标是术后14天和30天的SSI诊断。分类变量采用χ检验进行比较，连续变量采用Wilcoxon秩和检验进行比较。P值小于0.05被认为具有统计学意义。
总共纳入813例病例进行分析，其中196例接受了术后口服类固醇（甲泼尼龙）6天疗程，617例未接受。两组的SSI发生率分别为4.1%和3.1%，在任何术后时间两组之间均无统计学差异。对诊断为SSI的患者进行亚组分析发现，在比较接受术后口服皮质类固醇的患者与未接受的患者时，人口统计学因素或医疗合并症无统计学差异。
成人上肢手术后使用低剂量口服类固醇是安全的，不会增加SSI风险。对术后口服皮质类固醇进行前瞻性研究的进一步调查将被证明是有益的。
