Preoperative Corticosteroid Use for Medical Conditions is Associated with Increased Postoperative Infectious Complications and Readmissions After Total Hip Arthroplasty: A Propensity-Matched Study
Dr. Boddapati is a Resident, Columbia University Medical Center, Department of Orthopedic Surgery, New York, New York. Dr. Fu is a Resident, Hospital for Special Surgery, New York, New York. Dr. Su is an Attending, Hospital for Special Surgery, New York, New York. Dr. Sculco is an Attending, Hospital for Special Surgery, New York, New York. Dr. Bini is an Attending, University of California, San Francisco, San Francisco, California. Dr. Mayman is an Attending, Hospital for Special Surgery, New York, New York.
Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Address correspondence to: Venkat Boddapati, BA, 161 Fort Washington Avenue; New York, NY 10032 (tel, 630-399-4122; email, venkatboddapati1@gmail.com).
Am J Orthop. 2018;47(12). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
Venkat Boddapati, BA Michael C. Fu, MD, MHS Edwin P. Su, MD Peter K. Sculco, MD Stefano A. Bini, MD David J. Mayman, MD . Preoperative Corticosteroid Use for Medical Conditions is Associated with Increased Postoperative Infectious Complications and Readmissions After Total Hip Arthroplasty: A Propensity-Matched Study. Am J Orthop. December 10, 2018
TAKE-HOME POINTS
The rate of preoperative corticosteroid usage is low (3.7%).
Patients using preoperative corticosteroids had increased rates of total 30-day complications.
Adverse outcomes that are increased include infectious complications (eg, sepsis, urinary tract infection, surgical site infection).
Hospital readmissions are also increased in patients taking preoperative corticosteroids, with the most common reason being infection.
Increased postoperative counseling and surveillance may be warranted in this patient population.
References
ABSTRACT
Systemic corticosteroids are used to treat a number of medical conditions; however, they are associated with numerous adverse effects. The impact of preoperative chronic corticosteroid use on postoperative outcomes following total hip arthroplasty (THA) is unclear. The purpose of this study was to assess the independent effect of chronic systemic preoperative steroid use on short-term perioperative complications and readmissions after THA.
All patients undergoing primary THA in the American College of Surgeons National Surgical Quality Improvement Program registry from 2005 to -–2015 were identified. Patients were considered chronic steroid users if they used any dosage of oral or parenteral steroids for >10 of the preceding 30 days before THA. Two equally sized propensity-matched groups based on preoperative steroid use were generated to account for differences in operative and baseline characteristics between the groups. Thirty-day complications and hospital readmissions rates were compared using bivariate analysis.
Of 101,532 THA patients who underwent primary THA, 3714 (3.7%) were identified as chronic corticosteroid users. Comparison of propensity-matched cohorts identified an increased rate of any complication (odds ratio [OR] 1.30, P = .003), sepsis (OR 2.07, P = .022), urinary tract infection (OR 1.61, P = .020), superficial surgical site infection (OR 1.73, P = .038), and hospital readmission (OR 1.50, P < .001) in patients who used systemic steroids preoperatively. Readmissions in preoperative steroid users were most commonly for infectious reasons.
Patients prescribed chronic corticosteroids are at a significantly increased risk of both 30-day periopative complications and hospital readmissions. This finding has important implications for pre- and postoperative patient counseling as well as preoperative risk stratification.
