• Author
    Casey Abernethy
  • Discovery PI

    Alexander B. Christ, MD

  • Project Co-Author

    Kole Joachim, BA, Tony Lam, BA, Brandon Gettleman, MD, Christopher Hamad, MD, Adrian Lin, MS, Othneil Sparks, BS, Amanda Perrotta, MS, Alexandra Stavrakis, MD

  • Abstract Title

    Interaction Between Chronic Steroid Use and ASA Class Predicts Major Adverse Events Following Outpatient Total Joint Arthroplasty

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Background: Outpatient total joint arthroplasty has experienced a substantial shift to outpatient settings in recent years. However, patient selection protocols remain variable across institutions. While the American Society of Anesthesiology (ASA) score is a predominant indicator of perioperative risk, it may not fully capture the clinically-relevant heterogeneity of higher-risk patients prescribed chronic steroids. Therefore, this study will jointly assess ASA score and chronic steroid risk in relation to 30-day major adverse events (MAE) following total hip/knee arthroplasty (THA/TKA). 

    Methods: We conducted a retrospective cohort study comparing 30-day MAE, among others, deep/organ-space surgical site infection and pulmonary embolism. From the ACS-NSQIP database (2019-2023), we stratified the combined cohort (249,328 total: 89,709 THA, 159,619 TKA) into four patient exposure groups: ASA I-II without steroids (reference), ASA I-II with steroids, ASA III-IV without steroids, and ASA III-IV with steroids. Multivariable logistic regression models were constructed to analyze THA and TKA cohorts independently and in combination. 

    Results: Relative to reference, THA patients with ASA score III-IV and chronic steroid use exhibited a nearly threefold risk increase in 30-day MAE (OR 2.87, 95%-CI: 2.27-3.64). TKA patients in the same group demonstrated just about a twofold increase in risk (OR 1.94, 95%-CI: 1.58-2.40). We also noted a procedure-specific difference in which chronic steroid use elicited more pronounced adverse effects in patients who underwent THA relative to TKA (interaction OR 0.67, 95%-CI: 0.49-0.92). This relationship suggests a procedure-specific vulnerability in conjunction with physiologic risk and immunosuppression. 

    Conclusion: Higher ASA class and chronic steroid use were independently and synergistically associated with increased risk of 30-day MAE following outpatient THA and TKA. Consequently, integrating steroid status into refining patient selection protocols is essential to optimizing perioperative risk.

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