When Is It Safe to Operate After Therapeutic Carpal Tunnel Injections?

Background: Recent studies suggest increased complications when surgery closely follows corticosteroid injection. The purpose of this study was to understand the occurrence of surgical site infection (SSI), wound complications, and reoperation rates after carpal tunnel release (CTR) when corticosteroid injections were given within 180 days preoperatively.

Methods: Data were collected from the Truven MarketScan database from 2009 to 2018. Cohorts were created based on preoperative timing of injection (<30, 30-60, 61-90, 91-180 days) and number of injections (0, 1, 2, 3+). Logistic regression was performed to assess the contribution of preoperative injections on 90-day surgical site complications and 1-year reoperation while controlling for demographics and comorbidities.

Results: Overall, 223 899 patients underwent CTR. Of these, 17 391 (7.76%) had a preoperative injection in the 180 days preceding surgery. Univariate analysis demonstrated a relationship between timing of injections and noninfectious wound complications ( = .006) and rate of 1-year reoperation ( = .045). Univariate analysis demonstrated a relationship between number of injections and 1-year reoperation ( < .001). On multivariate analysis, those receiving injections within 30 days preoperatively had increased rates of SSI ( = .034) and noninfectious wound complications ( = .006) compared with those with no injection or at other time points. Patients with 2 ( = .002) or 3 or more injections ( < .001) in the 180-day preoperative period had increased odds of 1-year reoperation.

Conclusion: Our study suggests increased risk of SSI, wound complications, and 1-year reoperation when corticosteroid injections are administered in the 30-day preoperative period. In addition, multiple steroid injections may increase the risk of 1-year reoperation.