Chronic Corticosteroid Use a Risk Factors for TJA Complications

Osteoarthritis (OA) may occur either due to or in conjunction with conditions including rheumatoid arthritis and systemic lupus erythematosus, both of which may be treated with chronic corticosteroids. OA patients whose disease progresses may eventually require a total joint arthroplasty (TJA), and chronic corticosteroid use has been linked to worse surgical outcomes. A retrospective study evaluated the correlation between chronic corticosteroid use and TJA complications.

Current Procedural Terminology codes were used to locate TJA patients in the American College of Surgeons National Surgical Quality Improvement Program, who were then stratified by chronic corticosteroid use.

A total of 403,566 TJA patients were identified, of whom 14,774 were on chronic corticosteroid regimens. Patients prescribed corticosteroids had significantly higher rates of surgical site infection (SSI; P=0.0001); wound dehiscence (P<0.0001); general wound infection (P<0.0001); pneumonia (P<0.0001); urinary tract infection (P<0.0001); readmission (P<0.0001); and occurrences of deep incisional SSI (P<0.0001), organ space SSI (P<0.0001), and unplanned intubation (P=0.0002). There were no significant between-group differences in terms of 30-day mortality, venous thromboembolic event, cerebrovascular accident, myocardial infarction, cardiac arrest, deep vein thrombosis, or sepsis.

“Many of the notable differences in complications may be directly attributed to the immunosuppressive nature of corticosteroids. With increased knowledge of which perioperative complications to monitor, surgeons can tailor treatment strategies to this population that reduce morbidity and improve outcomes,” the study authors concluded.