Effect Of Chronic Steroid Use On Postoperative Infections And Readmission In Anatomic And Reverse TSA

PURPOSE: Anatomic and reverse total shoulder arthroplasty (aTSA/rTSA) have become prominent treatments for glenohumeral joint pathologies, but the role of chronic preoperative steroid use in aTSA/rTSA outcomes remains underexplored. Complications related to chronic preoperative steroid use are under appreciable scrutiny in hip, knee, and lumbar surgeries. For shoulder surgeries, however, particularly arthroplasty, the literature is extremely limited. This study aimed to investigate the relationship between chronic preoperative steroid use and aTSA/rTSA outcomes. METHODS: This retrospective analysis used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) spanning from 2010-18. Clinical data including preoperative demographics, operative variables, and 30-day post-TSA outcomes were collected. Conditional logistic regression was employed with propensity score matching between groups. RESULTS: A total of 3,445 identified cases were included in this analysis, with 1,157 exhibiting chronic steroid use. The steroid group had significantly greater rates of readmission (OR: 1.86; 95% CI: 1.22-2.81; P = 0.004). No significant differences were observed between groups for all other adverse outcomes. CONCLUSIONS: Chronic preoperative steroid use is an independent predictor of readmission but not infectious outcomes following aTSA/rTSA. Further investigation with longer follow-up will help elucidate the impact of chronic preoperative steroid use on infectious outcomes and enhance risk assessments in chronic steroid users undergoing aTSA/rTSA. Table 1. - Patient characteristics in patients treated with aTSA/rTSA, categorized by steroid use Variable No Steroid Use (n = 2288) Steroid Use (n = 1157) Standardized Difference Age (Years) 68.9 ± 10.4 68.1 ± 10.5 .076 Sex (Female) 1475 (64.5%) 797 (68.9%) .093 Race (White) 1969 (86.1%) 934 (80.7%) .147 Body Mass Index 29.8 ± 6.4 30.1 ± 6.9 .045 Functional Status (Dependent) 81 (3.6%) 41 (3.6%) .000 Smoker (Within 1 year) 230 (10.1%) 127 (11.0%) .030 American Society of Anesthesiologists (ASA) Classification Score 2.7 ± 0.6 2.8 ± 0.5 .186 Diabetes 346 (15.1%) 182 (15.7%) .017 Hypertension 1551 (67.8%) 776 (67.1%) .015 COPD 268 (11.7%) 167 (14.4%) .082 Dyspnea 279 (12.2%) 157 (13.6%) .041 Congestive Heart Failure 14 (0.6%) 18 (1.6%) .098 Operation Time (Minutes) 114.3 ± 46.2 106.4 ± 50.5 .169 Table 2. - Conditional logistic regression model for aTSA/rTSA outcomes based upon steroid use Outcome Occurrences (Steroid Use) Occurrences (No Steroid Use) Odds Ratio 95% Confidence Interval P-Value Surgical Site Infection 3 (0.3%) 4 (0.2%) 1.50 0.34-6.70 0.596 Deep Incisional Infection 1 (0.1%) 3 (0.1%) 0.67 0.07-6.41 0.725 Organ Space Infection 1 (0.1%) 1 (<0.1%) 2.00 0.13-31.98 0.624 Pneumonia 8 (0.7%) 15 (0.7%) 1.07 0.45-2.52 0.883 Urinary Tract Infection 17 (1.5%) 28 (1.2%) 1.21 0.67-2.22 0.528 Sepsis 3 (0.3%) 10 (0.4%) 0.60 0.17-2.18 0.438 Septic Shock 3 (0.3%) 3 (0.1%) 2.00 0.40-9.91 0.396 Any Infection 32 (2.8%) 53 (2.3%) 1.21 0.78-1.87 0.400 Reoperation 17 (0.5%) 18 (0.8%) 1.89 0.97-3.67 0.060 Readmission 44 (3.8%) 46 (2.0%) 1.86 1.22-2.81 0.004