The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

• Published in: Journal of clinical orthopaedics and trauma Vol. 11; no. 5; pp. 921 - 927
• Main Authors: Tihista, Mikel, Gu, Alex, Wei, Chapman, Weinreb, Jeffrey H., Rao, Raj D.
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.09.2020; Elsevier
• Subjects: Complications; Corticosteroid use; Lumbar decompression; National surgical quality improvement program; IL; OR; Complications; ACS NSQIP; CPT; IDDM; Corticosteroid use; DM; ICD; UTI; ASA; LOS; Lumbar decompression; ANOVA; MAC/IV; National surgical quality improvement program; BMI; NIDDM; IL, Interleukin; NIDDM, Non-Insulin dependent diabetes mellitus; DM, diabetes mellitus; CPT, Current Procedure Terminology; UTI, Urinary Tract Infection; IDDM, Insulin Dependent Diabetes Mellitus; BMI, Body Mass Index; MAC/IV, Monitored Anesthesia Care, Intravenous: NIDDM; ANOVA, Analysis of Variance; LOS, Length of Stay; ASA, American Society of Anesthesiologists; OR, Odds Ratio; ACS NSQIP, American College of Surgery National Surgical Quality Improvement Program; ICD, International Classification of Disease
• ISSN: 0976-5662; 2213-3445
• DOI: 10.1016/j.jcot.2020.04.010

Corticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine. A retrospective cohort study was conducted using data collected from the National Surgical Quality Improvement Program database data from 2005 to 2016. Lumbar decompression surgeries, including discectomies, laminectomies, and others were identified using CPT codes. Chi-square analysis was used to evaluate differences among the corticosteroid and non-corticosteroid groups for demographics, preoperative comorbidities, and postoperative complications. Logistic regression analysis was done to determine if long-term corticosteroid use predicts incidence of postoperative infections following adjustment. 26,734 subjects met inclusion criteria. A total of 1044 patients (3.9%) were on long-term corticosteroids prior to surgical intervention, and 25,690 patients (96.1%) were not on long-term corticosteroids. Patients on long-term corticosteroids were more likely to be older (p < 0.001), female (p < 0.001), nonsmokers (p < 0.001), and have a higher American Society of Anesthesiologist class (p < 0.001). Multivariate analysis demonstrated that long-term corticosteroid usage was associated with increased overall complications (odds ratio [OR]: 1.543; p < 0.001), and an independent risk factor for the development of minor complications (OR: 1.808; p < 0.001), urinary tract infection (OR: 2.033; p = 0.002), extended length of stay (OR: 1.244; p = 0.039), thromboembolic complications (OR: 1.919; p = 0.023), and sepsis complications (OR: 2.032; p = 0.024). Long-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.