Ipsilateral Preoperative Corticosteroid Injection and Timing Not Associated With Postoperative Deep Infection After...

Previous literature reports an increased risk of postoperative infection with preoperative corticosteroid injection (CSI) before carpal tunnel release (CTR), although the temporal nature of this risk remains unclear. A large administrative claims database was used to answer the following: (1) Is CSI within 90 days before CTR associated with higher postoperative deep infection (PDI) rates? (2) When stratified by 0 to 30 days, 31 to 60 days, and 61 to 90 days before CTR, is CSI timing associated with higher PDI rates?

Patients who underwent endoscopic or open CTR were identified in the PearlDiver M170 database. Exclusion criteria included concomitant hand procedure, age younger than 18 years, unspecified or bilateral carpal tunnel syndrome, and insufficient postoperative data. Patients who received ipsilateral CSI within 90 days before CTR or no CSI were matched by age, sex, Elixhauser Comorbidity Index, hypertension, diabetes, obesity, rheumatoid arthritis, thyroid disorders, and tobacco use. Patients with a preoperative CSI before CTR were further stratified into those who received CSI 0 to 30 days, 31 to 60 days, and 61 to 90 days. Demographic variables between matched cohorts were compared using chi-squared or Kruskal-Wallis tests. Chi-squared tests were used to determine association between CSI timing and 30-, 60-, and 90-day PDI requiring surgical intervention.

Each matched cohort included 17,125 patients. No notable increase in PDI risk was observed in the CSI cohort who relative to controls. Secondary analysis by preoperative CSI timing of 0 to 30, 31 to 60, or 61 to 90 days similarly did not reveal any notable increase in PDI risk relatives to controls.

The reported findings suggest that preoperative CSI, at all studied timepoints, was not associated with increased risk of PDI, a divergence from existing literature. Surgeons should consider these findings when evaluating risks and benefits of nonsurgical and surgical treatments for carpal tunnel syndrome.