The Effect of Steroids on Complications, Readmission, and Reoperation After Posterior Lumbar Fusion

Michael B. Cloney*, Roxanna M. Garcia, Zachary A. Smith, Nader S. Dahdaleh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: The effects of chronic corticosteroid therapy on complications, readmission, and reoperation after posterior lumbar fusion (PLF) remain underinvestigated, and were examined to determine differences in outcomes. Methods: We analyzed patients undergoing PLF between 2006 and 2013 using the National Surgery Quality Improvement Program database (NSQIP). Patients taking steroids for a chronic condition were compared with those not taking steroids. Multivariable regression identified factors independently associated with complications, readmission, and reoperation. A risk score was calculated for predicting complications. Results: A total of 8492 patients were identified, of whom 353 used steroids. The patients using steroids were older (mean age, 65.4 years vs. 61.0 years; P < 0.001), were more likely to be female (61.2% vs. 55.1%; P = 0.025), had a higher American Society of Anesthesiologists class (P < 0.001), were less likely to be functionally independent (90.3% vs. 96.5%; P < 0.001), and were more likely to have a history of hypertension (69.1% vs. 58.3%; P < 0.001), diabetes mellitus (21.8% vs. 17.4%; P = 0.033), cardiac disease (74.8% vs. 66.1%; P = 0.001), and/or severe chronic obstructive pulmonary disease (10.5% vs. 4.2%; P < 0.001). The rates of readmission (9.4% vs. 6.0%; P = 0.023), reoperation (6.5% vs. 3.6%; P = 0.004), overall complications (14.5% vs. 9.6%; P = 0.003), and infections (9.6% vs. 5.1%; P < 0.001) were higher in the steroid group. On multivariable regression, steroids were independently associated with overall complications (odds ratio [OR], 1.38; P = 0.044) and infectious complications (OR, 1.65; P < 0.001), but not with medical complications, readmission, or reoperation. Patients with higher risk scores had higher complication rates. Conclusions: The use of corticosteroid therapy is associated with a moderately increased risk of overall complications, but no association was found with readmission or reoperation.

Original languageEnglish (US)
Pages (from-to)e526-e533
JournalWorld neurosurgery
Volume110
DOIs
StatePublished - Feb 2018

Keywords

  • Complications
  • Corticosteroids
  • Fusion
  • Posterior lumbar fusion
  • Spinal fusion
  • Steroids

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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