Chronic Corticosteroid Use Is Associated with Higher Perioperative Morbidity After Elective Primary Total Hip Arthroplasty

Background: Chronic corticosteroids are commonly prescribed for autoimmune and inflammatory disorders, yet their impact on perioperative outcomes following elective total hip arthroplasty (THA) remains incompletely defined. This study evaluated the association between chronic corticosteroid use and postoperative complications and hospital outcomes after elective primary THA. Methods: We performed a retrospective cohort study using the National Inpatient Sample (2016–2021). Adult patients undergoing elective primary THA were identified using ICD-10-PCS codes. Chronic corticosteroid use was defined by ICD-10-CM code Z79.52. The primary outcome was any postoperative complication, including venous thromboembolism (VTE), major bleeding, acute kidney injury, myocardial infarction, stroke, or sepsis. Secondary outcomes included prolonged length of stay, high hospital charges, discharge to rehabilitation, and in-hospital mortality. Multivariable weighted logistic regression and 1:1 propensity score matching (PSM) was applied. Results: The weighted cohort represented approximately 600,000 hospitalizations, of which 0.91% involved chronic steroid use. Steroid users had a higher burden of comorbidities. After adjustment, chronic corticosteroid use was independently associated with increased odds of any postoperative complication (OR 1.32), major bleeding (OR 1.46), prolonged hospitalization (OR 1.26), discharge to rehabilitation (OR 1.06), and in-hospital mortality (OR 2.53). In the matched cohort (1079 pairs), steroid use remained significantly associated with overall complications (OR 1.84) and acute kidney injury (OR 2.10). Conclusions: Although uncommon, chronic corticosteroid use is associated with a clinically meaningful increase in perioperative morbidity after elective THA. These findings highlight chronic corticosteroid use as a marker of increased perioperative risk that warrants greater clinical recognition, and they provide hypothesis-generating evidence to inform future studies of perioperative management in this population.