Preoperative Hypoglycemia Increases Infection Risk Following Trigger Finger Injection and Release

Background: Diabetes mellitus is a well-known risk factor for infection following trigger finger (TF) injection and/or release. However, the effect of preoperative hypoglycemia prior to TF injection or release is currently unknown. The purpose of this study is to determine the effects of hypoglycemia or hyperglycemia on infection incidence following TF injection or release.

Methodology: A retrospective cohort review between 2007 and 2015 was conducted using a national private payer database within the PearlDiver Supercomputer. Preoperative, fasting, glucose levels were collected for each patient and these ranged from 20 mg/dL to 219 ml/dL. Infection rates at 90-day and one-year post-procedural intervals were determined using ICD-9 codes.

Results: The query of the PearlDiver database returned 153,479 TF injections, of which 3,479 (2.27%) and 6,276 (4.09%) had infections at the 90-day and one-year intervals, respectively. There were 70,290 TF releases identified, with 1,887 (2.68%) 90-day and 3,144 (4.47%) one-year infections. There was a statistically significant increase in infection rate in patients with hypoglycemia at the 90-day (p=0.006) and one-year (p<0.001) time interval following TF injection. Likewise, a statistically significant increase in infection rate in patients with hypoglycemia undergoing TF release at the one-year time interval was seen, p=0.003. There was no statistical relation between hyperglycemia and infection after TF injection or release at the 90-day or one-year time intervals.

Conclusions: Hypoglycemia prior to TF injection or release increases the risk for infection. Tight glycemic control may be warranted to mitigate this risk. Further studies are needed to investigate the effect of hypoglycemia as an independent risk factor for infection.