Systematic review of intraoperative corticosteroid injections and the risk of infection in arthroscopic surgery

Background: Despite the fact that preoperative corticosteroid injections within three to six months of surgery increase the risk of postoperative infection, there is a growing trend of using corticosteroid injections intraoperatively as an effort to decrease postoperative pain and opiate use. Our aim with this review was to answer the question “Do intraoperative corticosteroid injections increase the risk of infections in arthroscopic surgery?” Methods: A systematic search of MEDLINE, Cochrane, and PMC databases was conducted adhering to PRISMA 2020 guidelines after registration with PROSPERO (ID: CRD42023459138). We included studies comparing infection rates in patients who received intraoperative corticosteroid injections (IOCSI) to those who received no injection. The MINORS risk of bias tool was used to assess the quality of included studies. Results: 305 individual records were screened and a total of 8 studies met the criteria for inclusion in the study, containing data from over 700,000 patient records. All 7 retrospective studies showed an increase in infection rates and the single small randomized controlled trial had no infections in either the control or intervention group. The combined weighted odds ratio of infection rates in comparable studies was 2.23 95% CI (1.66–3.11). Conclusions: Current data shows that IOCSIs more than double the risk of postoperative infection during arthroscopic surgery. Surgeons should consider and weigh the impact of infection to the minor clinical benefit corticosteroid injections add over other multimodal injections. We expect similar increases in infection rates in other surgeries where IOCSIs are used due to the inherent immunosuppressive mechanisms of corticosteroids.