Chronic steroid use as a risk factor for postoperative complications following arthroscopic rotator cuff repair

Abstract

Steroids are a common treatment for many rheumatologic and inflammatory disorders. Chronic steroid use has been studied in joint arthroplasty and arthroscopy, but studies specifically on preoperative chronic steroid use in arthroscopic rotator cuff repair (aRCR) are limited. The purpose of this study is to determine the association between chronic steroid use and 30-day postoperative outcomes following aRCR. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to identify all patients who underwent aRCR between 2015 and 2020. Patients were divided into 2 cohorts: nonsteroid users and chronic steroid users. Univariate binomial regression analysis was used to compare demographics, comorbidities, and postoperative outcomes between cohorts. Multivariate regression analysis, adjusted for all significant demographics and comorbidities, was used to identify significant 30-day postoperative outcomes. A total of 39,876 patients remained after exclusion criteria, with 39,068 (97.97%) in the nonsteroid group and 808 (2.02%) in the chronic steroid group. Patient demographics and comorbidities significantly associated with chronic steroid use were age ≥65 (P<.001), female gender (P<.001), body mass index (BMI) ≥35, American Society of Anesthesiologists (ASA) ≥3 (P<.001), dependent functional status (P<.001), nonsmokers (P=.046), higher rates of dyspnea (P<.001), chronic obstructive pulmonary disease (COPD) (P<.001), congestive heart failure (P<.001), hypertension requiring medication (P<.001), open wound infection (P=.018), unintentional weight loss (P<.001), bleeding disorders (P<.001), and inpatient procedure (P=.013). Multivariate analysis found preoperative chronic steroid use to be an independent predictor of mortality within 30 days following aRCR (OR 8.15, confidence interval (CI) 1.45-45.86; P=.017). Chronic steroid use was not found to be an independent risk factor for infection, readmission, or reoperation following aRCR. It was, however, found to be independently associated with higher rates of 30-day mortality following aRCR, although with a limited overall number of deaths reported.