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Long-Term Oral Steroid Use: A Unique Risk Factor in 4-Corner Fusion Compared With Other Wrist Salvage Operations.
William N Newton1, Charles A Johnson1, Dane N Daley1
1Medical University of South Carolina, Charleston, USA.
Hand (New York, N.Y.)
|February 8, 2023
Summary
Long-term oral corticosteroid use increases complications, particularly surgical site infections, after 4-corner fusion for wrist arthritis. This risk was not observed with other wrist salvage procedures.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Patient Safety
Background:
- Wrist arthritis salvage procedures like 4-corner fusion have high complication rates.
- Long-term oral glucocorticoid therapy is a known risk factor for orthopedic complications.
Purpose of the Study:
- To investigate the impact of preoperative corticosteroid use on complications following wrist salvage operations.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program database (2005-2020).
- Inclusion of patients undergoing proximal row carpectomy, 4-corner fusion, total wrist arthroplasty, or total wrist fusion.
- Statistical analysis using univariate and multivariate logistic regression to assess complication risks based on steroid use.
Main Results:
- Steroid use was independently associated with a higher overall complication rate.
- In 4-corner fusion patients, steroid use correlated with increased complications and surgical site infections.
- No increased complications were linked to steroid use in proximal row carpectomy, total wrist arthroplasty, or total wrist fusion.
Conclusions:
- Long-term oral corticosteroid therapy elevates postoperative infection risk specifically for 4-corner fusion in wrist arthritis.
- This association was not identified for other wrist salvage procedures, suggesting procedure-specific risks.
