Purpose
To define the incidence of postoperative infections in patients who receive corticosteroid
injections prior to arthroscopic meniscectomy, to determine whether there is a temporal
relation between injections and the risk of surgical-site infections, and to identify
corresponding risk factors.
Methods
The Humana administrative claims database was reviewed for patients undergoing arthroscopic
meniscectomy within 1 year of injection and those undergoing arthroscopic meniscectomy
without prior injection. Patients with preoperative injections were further stratified
by the duration in months between the injection and the surgical procedure. Surgical-site
infection within 6 months of surgery was recorded. Univariate analysis and binary
logistic regression were performed to determine independent risk factors for surgical-site
infection. Statistical significance was defined as P < .05.
Results
We identified patients with (n = 11,652) and without (n = 37,261) a history of a knee
corticosteroid injection within 1 year of arthroscopic meniscectomy with at least
6 months of database activity from 2007 to 2017. In patients who received knee injections
within 1 month prior to surgery, the rate of development of postoperative infections
was twice that in patients who did not receive an injection (1.28% vs 0.63%; odds
ratio [OR], 1.84; 95% confidence interval [CI], 1.24-2.62; P = .001). Multivariate logistic regression identified male sex (OR, 1.39; 95% CI,
1.14-1.71; P = .001), diabetes (OR, 1.48; 95% CI, 1.19-1.85; P < .001), chronic obstructive pulmonary disease (OR, 1.57; 95% CI, 1.27-1.94; P < .001), obesity (OR, 1.32; 95% CI, 1.07-1.63; P = .010), tobacco use (OR, 1.61; 95% CI, 1.30-1.98; P < .001), and preoperative injections within 1 month of surgery (OR, 1.78; 95% CI,
1.21-2.54; P = .002) as significant predictors, whereas injections administered more than 1 month
before surgery were not significantly associated with postoperative surgical-site
infection after arthroscopic meniscectomy.
Conclusions
Injections 1 month before arthroscopic meniscectomy significantly increase the risk
of surgical-site infection. However, injections can be safely administered more than
1 month prior to surgery because there is no increased risk of postoperative infection
at this time point.
Level of Evidence
Level III, retrospective cohort study.
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Article Info
Publication History
Published online: March 30, 2021
Accepted:
February 28,
2021
Received:
November 4,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: B.F. receives research support from Arthrex, Smith & Nephew, and Stryker; receives publishing royalties and financial or material support from Elsevier; owns stock or stock options in Jace Medical; and is a paid consultant for Stryker, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
