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The Timing of Injections Prior to Arthroscopic Rotator Cuff Repair Impacts the Risk of Surgical Site Infection

Forsythe, Brian, MD1; Agarwalla, Avinesh, BS1; Puzzitiello, Richard N., BS1; Sumner, Shelby, MPH1; Romeo, Anthony A., MD2; Mascarenhas, Randy, MD, FRCSC3

doi: 10.2106/JBJS.18.00631
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Background: Corticosteroid injections are a common treatment for rotator cuff tears. Because of concerns of infection, a surgical procedure is often delayed following injections. The purpose of this investigation was to determine if there is a temporal relationship between corticosteroid injections and the risk of surgical site infection after arthroscopic rotator cuff repair. We hypothesized that the incidence of surgical site infection is higher in patients who received a preoperative injection and this relationship exists in a temporal manner as those patients receiving an injection closer to the operative date have a higher risk of infection.

Methods: The PearlDiver database was reviewed for patients undergoing arthroscopic rotator cuff repair from 2007 to 2016. Patients were stratified into 2 cohorts: those undergoing arthroscopic rotator cuff repair within 1 year of injection (n = 12,060), and those undergoing arthroscopic rotator cuff repair without prior injection (n = 48,763). Patients with preoperative injections were further stratified by the duration in months that the injection was performed prior to the surgical procedure. Surgical site infection within 6 months of the surgical procedure was recorded. Statistical analysis included chi-square and multivariate binomial logistic regression analyses to identify risk factors for surgical site infection. Results were considered significant at p < 0.05.

Results: There was no significant difference in the incidence of surgical site infection in patients receiving a shoulder injection at 0.7% compared with the control cohort at 0.8% (odds ratio [OR], 0.9 [95% confidence interval (CI), 0.7 to 1.1]; p = 0.2). However, patients receiving an injection within 1 month prior to operative management had a significantly higher rate of surgical site infection overall at 1.3% compared with the control group at 0.8% (OR, 1.7 [95% CI, 1.0 to 2.9]; p = 0.04). On multivariate analysis, male sex (OR, 1.7 [95% CI, 1.4 to 1.9]; p = 0.001), obesity (OR, 1.4 [95% CI, 1.2 to 1.6]; p < 0.001), diabetes (OR, 1.3 [95% CI, 1.1 to 1.5]; p < 0.001), smoking status (OR, 1.7 [95% CI, 1.4 to 1.9], p < 0.001), and preoperative corticosteroid injections within 1 month of the surgical procedure (OR, 2.1 [95% CI, 1.5 to 2.7]; p < 0.001) were independent risk factors for development of a surgical site infection.

Conclusions: Injections within 1 month of arthroscopic rotator cuff repair significantly increases the risk of surgical site infection. However, there is no increased risk of infection if the surgical procedure is delayed by 1 month following an injection.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois

2Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, Pennsylvania

3McGovern Medical School, University of Texas Health Science Center, Houston, Texas

E-mail address for B. Forsythe: brian.forsythe@rushortho.com

E-mail address for A. Agarwalla: avinesh.agarwalla@icloud.com

E-mail address for R.N. Puzzitiello: puzzitrn@gmail.com

E-mail address for S. Sumner: shelby.sumner@rushortho.com

E-mail address for A.A. Romeo: romeoortho@gmail.com

E-mail address for R. Mascarenhas: mascarer@hotmail.com

Investigation performed at Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois

A commentary by Samer S. Hasan, MD, PhD, is linked to the online version of this article at jbjs.org.

Disclosure: There was no source of external funding for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F212).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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