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Association between in situ steroids and spine surgical site infections among instrumented procedures
Published online by Cambridge University Press: 08 March 2023
Abstract
Objective:
To estimate the association between in situ steroids and spine surgical-site infections (SSIs), assessing spinal instrumentation as an effect modifier and adjusting for confounders.
Design:
Case–control study.
Setting:
Rural academic medical center.
Participants:
We identified 1,058 adults undergoing posterior fusion and laminectomy procedures as defined by the National Healthcare Safety Network without a pre-existing SSI between January 2020 and December 2021. We identified 26 SSI as cases and randomly selected 104 controls from the remaining patients without SSI.
Methods:
The primary exposure was the intraoperative administration of methylprednisolone in situ (ie, either in the wound bed or as an epidural injection). The primary outcome was a clinical diagnosis of SSI within 6 months of a patient’s first spine surgery at our facility. We quantified the association between the exposure and outcome using logistic regression, using a product term to assess for effect modification by spinal instrumentation and the change-in-estimate approach to select significant confounders.
Results:
Adjusting for Charlson comorbidity index and malignancy, in situ steroids were significantly associated with spine SSI relative to no in situ steroids for instrumented procedures (adjusted odds ratio [aOR], 9.93; 95% confidence interval [CI], 1.54–64.0), but they were not associated with spine SSIs among noninstrumented procedures (aOR, 0.86; 95% CI, 0.15–4.93).
Conclusions:
In situ steroids were significantly associated with spine SSI among instrumented procedures. The benefits of in situ steroids for pain management following spine surgery should be weighed against the risk of SSI, especially for instrumented procedures.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Waqas, M, Shallwani, H, Shamim, MS, Ahmad, K. Perioperative steroids for lumbar disc surgery: a meta-analysis of randomized controlled trials. Surg Neurol Int 2017;8:42.Google Scholar
Wilson-Smith, A, Chang, N, Lu, VM, et al. Epidural steroids at closure after microdiscectomy/laminectomy for reduction of postoperative analgesia: systematic review and meta-analysis. World Neurosurg 2018;110:e212–e221.CrossRefGoogle ScholarPubMed
Wicke, C, Halliday, B, Allen, D, et al. Effects of steroids and retinoids on wound healing. Arch Surg 2000;135:1265–1270.10.1001/archsurg.135.11.1265CrossRefGoogle ScholarPubMed
Duman, E, Ceylan, KC, Akpınar, D, et al. The effects of steroidal and nonsteroidal anti-inflammatory drugs on tracheal wound healing in an experimental rat model. Interact Cardiovasc Thorac Surg 2020;30:646–651.10.1093/icvts/ivz309CrossRefGoogle Scholar
Aszodi, A, Ponsky, JL. Effects of corticosteroid on the healing bowel anastomosis. Am Surg 1984;50:546–548.Google Scholar
Patel, HA, Cheppalli, NS, Bhandarkar, AW, Patel, V, Singla, A. Lumbar spinal steroid injections and infection risk after spinal surgery: a systematic review and meta-analysis. Asian Spine J 2022;16:947–957.10.31616/asj.2021.0164CrossRefGoogle Scholar
Gu, W, Tu, L, Liang, Z, et al. Incidence and risk factors for infection in spine surgery: a prospective multicenter study of 1,764 instrumented spinal procedures. Am J Infect Control 2018;46:8–13.10.1016/j.ajic.2017.09.025CrossRefGoogle Scholar
Apisarnthanarak, A, Jones, M, Waterman, BM, Carroll, CM, Bernardi, R, Fraser, VJ. Risk factors for spinal surgical-site infections in a community hospital: a case–control study. Infect Control Hosp Epidemiol 2003;24:31–36.10.1086/502112CrossRefGoogle Scholar
Boston, KM, Baraniuk, S, O’Heron, S, Murray, KO. Risk factors for spinal surgical site infection, Houston, Texas. Infect Control Hosp Epidemiol 2009;30:884–889.CrossRefGoogle ScholarPubMed
Haleem, A, Chiang, HY, Vodela, R, et al. Risk factors for surgical site infections following adult spine operations. Infect Control Hosp Epidemiol 2016;37:1458–1467.CrossRefGoogle ScholarPubMed
Hollenbeck, BL, McGuire, KJ, White, AP, Yassa, DS, Wright, SB. Invasiveness index as a predictor of surgical-site infection after spinal fusion, revision fusion, or laminectomy. Infect Control Hosp Epidemiol 2017;38:11–17.10.1017/ice.2016.244CrossRefGoogle Scholar
Namba, T, Ueno, M, Inoue, G, et al. Prediction tool for high risk of surgical site infection in spinal surgery. Infect Control Hosp Epidemiol 2020;41:799–804.10.1017/ice.2020.107CrossRefGoogle Scholar
Walsh, TL, Querry, AM, McCool, S, et al. Risk factors for surgical site infections following neurosurgical spinal fusion operations: a case–control study. Infect Control Hosp Epidemiol 2017;38:340–347.CrossRefGoogle ScholarPubMed
2022 Operative procedure code documents. Center for Disease Control and Prevention website. https://www.cdc.gov/nhsn/psc/ssi/index.html. Published online June 2022. Accessed October 3, 2022.Google Scholar
Hayes-Larson, E, Kezios, KL, Mooney, SJ, Lovasi, G. Who is in this study, anyway? Guidelines for a useful Table 1. J Clin Epidemiol 2019;114:125–132.10.1016/j.jclinepi.2019.06.011CrossRefGoogle Scholar
Akinduro, OO, Miller, BA, Haussen, DC, Pradilla, G, Ahmad, FU. Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis. Neurosurg Focus 2015;39(4):E12.10.3171/2015.7.FOCUS15269CrossRefGoogle Scholar
Bednar, DA, Wong, A, Farrokhyar, F, Paul, J. Dexamethasone perioperative coanalgesia in lumbar spine fusion: a controlled cohort study of efficacy and safety. J Spinal Disord Tech 2015;28:E422–E426.10.1097/BSD.0b013e3182a1ddd3CrossRefGoogle Scholar
Fletcher, ND, Ruska, T, Austin, TM, Guisse, NF, Murphy, JS, Bruce, RW. Postoperative dexamethasone following posterior spinal fusion for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2020;102:1807–1813.10.2106/JBJS.20.00259CrossRefGoogle Scholar
Haws, BE, Khechen, B, Patel, DV, et al. Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial. J Neurosurg Spine 2018;30:222–227.10.3171/2018.7.SPINE18584CrossRefGoogle Scholar
Elsamadicy, AA, Wang, TY, Back, AG, et al. Impact of intraoperative steroids on postoperative infection rates and length of hospital stay: a study of 1200 spine surgery patients. World Neurosurg 2016;96:429–433.10.1016/j.wneu.2016.09.057CrossRefGoogle Scholar
Polderman, JA, Farhang-Razi, V, Van Dieren, S, et al. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev 2018;11:CD011940.Google Scholar
Lee et al. supplementary material
Figure 1 and Tables S1-S3
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