Corticosteroid Injections 1 Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical-Site Infection.

ABSTRACT

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.