ADVERTISEMENT

Preoperative Corticosteroid Use for Medical Conditions is Associated with Increased Postoperative Infectious Complications and Readmissions After Total Hip Arthroplasty: A Propensity-Matched Study

December 10, 2018 | Surgery
Venkat Boddapati, BA ; Michael C. Fu, MD, MHS ; Edwin P. Su, MD ; Peter K. Sculco, MD ; Stefano A. Bini, MD ; David J. Mayman, MD
Author and Disclosure Information

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.

CLINCIAL OUTCOMES BY STEROID STATUS

A comparison of unadjusted cohorts showed that patients who used preoperative steroids had an increased rate of any complication (7.89%) when compared with those who did not (4.87%) (Table 2). 

Bivariate Comparison of Adverse Outcomes in Unadjusted Cohorts by Steroid Status

Similarly, those who used corticosteroids preoperatively had an increased rate of renal complications, respiratory complications, return to the operating room, sepsis, UTI, superficial and deep SSI, and perioperative blood transfusions. They also were more likely to have a 30-day hospital readmission (P < .05 for all comparisons).

When propensity-matched cohorts were compared, patients who used steroids preoperatively were found to have higher rates of any complication (odds Ratio [OR] 1.30, P = .003), sepsis (OR 2.07, P = .022), UTI (OR 1.61, P = .020), superficial SSI (OR 1.73, P = .038), and hospital readmission (OR 1.50, P < .001; Table 3).

Bivariate Comparison of Adverse Outcomes in Propensity-Matched Cohorts by Steroid Status

REASONS FOR HOSPITAL READMISSION

In total, 3397 patients were readmitted to the hospital within thirty days. Of these, 226 used steroids preoperatively, and 3171 did not (Table 4). 

Reasons for Hospital Readmission after Total Hip Arthroplasty by Steroid Status

The most common reason for hospital readmission in patients who used preoperative corticosteroids was infectious complications (72 patients, 31.9% of all readmitted patients in this cohort), followed by medical complications (59 patients, 26.1%), and hip-related complications (48 patients, 21.2%). In those who did not use steroids preoperatively, the most common reason for hospital readmission was medical complications (932 patients, 29.4% of all readmitted patients in this cohort), followed by infectious complications (792 patients, 25.0%), and hip-related complications (763 patients, 24.1%).

Continue to: DISCUSSION

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT