Risk of Infection After Intra-articular Steroid Injection at the Time of Ankle Arthroscopy in a Medicare Population

Werner, Brian C.; Cancienne, Jourdan M.; Burrus, M. Tyrrell; Park, Joseph S.; Perumal, Venkat; Cooper, Minton Truitt

doi:10.1016/j.arthro.2015.07.029

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…It is possible that the immunosuppressive effect of a local steroid agent wears off after a specific time and thereafter does not contribute to any higher risk of infection. A similar increased infection risk has been reported after local preoperative injections in knee replacement 4 and ankle, 33 shoulder, 32 and hip 31 surgery if the injection was administered within 3 months prior to the surgery.…”

Section: Discussionmentioning

confidence: 56%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVELumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion.METHODSA nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI.RESULTSThe overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1–3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI.CONCLUSIONSLumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

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Section: Discussionmentioning

confidence: 56%

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Singla

Yang

Werner

et al. 2017

Journal of Neurosurgery: Spine

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“…The association of intra-articular corticosteroid injections and surgical site infection has been well documented in other orthopaedic subspecialties (8)(9)(10)(11). While there are some existing studies evaluating LESI and infection rates following spine surgery, these studies have shown conflicting results regarding the correlation between LESI and risk of post-operative infection with various spine procedures (6,7,12).…”

Section: Discussionmentioning

confidence: 99%

An epidural steroid injection in the 6 months preceding a lumbar decompression without fusion predisposes patients to post-operative infections

et al. 2018

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Background: To determine if the timing of a lumbar epidural steroid injection (LESI) effects rates of postoperative infection in patients receiving a non-fusion lumbar decompression (LDC) due to degenerative disc disease (DDD). Lumbar pain due to DDD can frequently be temporized or definitively treated with epidural injections. While there is ample literature regarding the infection risks associated with corticosteroid injections prior to hip/knee replacements, there are few studies relating to the spine. Methods: A nationwide insurance database was queried to identify those who underwent LDC for DDD without instrumentation [2005-2014]. Lumbar fusion procedures were excluded. From this group those with a history of a LESI were identified and matched to a control group without a history of LESI. Four separate cohorts were examined: (I) LDC and no LESI within 6 months (control); (II) LDC performed within 0-1 month after LESI; (III) LDC between 1 and 3 months after LESI; (IV) LDC performed between 3 and 6 months after LESI. Results: There was an increased odds of a 90-day postoperative infection if the LESI was within the 1-3 months (OR =4.69; P<0.001) and 3-6 months (OR =5.33; P<0.001) interval prior to the LDC. Conclusions: While LESI is helpful for possibly delaying or avoid lumbar surgery, it may predispose patients to higher infection rates following lumbar decompressions without fusion. Surgeons and pain management specialist should counsel patients on these risks and

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“…8 For native ankle joints, one study found a 3.9% infection risk when using intraoperative steroids versus a 1.8% infection risk when performing arthroscopy without steroids. 10 However, this study was not related to TAA, and many other studies in native ankle joint arthritis deny a relationship with steroid injections. The available literature investigating the effect of intraarticular corticosteroid injections on postoperative PJI are all in hip and knee arthroplasty patients.…”

Section: Rationalementioning

confidence: 65%

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019

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Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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Risk of Infection After Intra-articular Steroid Injection at the Time of Ankle Arthroscopy in a Medicare Population

Cited by 20 publications

References 23 publications

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

An epidural steroid injection in the 6 months preceding a lumbar decompression without fusion predisposes patients to post-operative infections

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

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