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Do Preoperative Corticosteroid Injections Increase the Risk for Infections or wound healing problems after Spine Surgery? A Swiss Prospective Multicenter Cohort Study


Farshad, Mazda; Burgstaller, Jakob M; Held, Ulrike; Steurer, Johann; Dennler, Cyrill (2018). Do Preoperative Corticosteroid Injections Increase the Risk for Infections or wound healing problems after Spine Surgery? A Swiss Prospective Multicenter Cohort Study. Spine, 43(15):1089-1094.

Abstract

STUDY DESIGN Prospective multi-center cohort study. OBJECTIVES This study evaluates the risk for surgical site infections (SSI) or wound healing problems (WHP) in patients who underwent corticosteroid injection prior to lumbar decompression surgery. SUMMARY OF BACKGROUND DATA Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly. METHODS The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either surgical site infections (n = 6) or wound healing problems (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes and BMI. Odds ratios were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after pre-operative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0-3 months before surgery, 0-6 months before surgery or any injection at all before surgery. RESULTS Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0-3 months before surgery (OR = 0.36, 95% CI 0.04-3.22), 0-6 months before surgery (OR = 0.69 95% CI 0.14-3.49) or any time before surgery (OR = 0.43, 95% CI 0.04-3.22). CONCLUSIONS Within the here investigated cohort, the risk of surgical site infections or wound healing problems following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously and is subject of further research. LEVEL OF EVIDENCE 2.

Abstract

STUDY DESIGN Prospective multi-center cohort study. OBJECTIVES This study evaluates the risk for surgical site infections (SSI) or wound healing problems (WHP) in patients who underwent corticosteroid injection prior to lumbar decompression surgery. SUMMARY OF BACKGROUND DATA Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly. METHODS The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either surgical site infections (n = 6) or wound healing problems (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes and BMI. Odds ratios were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after pre-operative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0-3 months before surgery, 0-6 months before surgery or any injection at all before surgery. RESULTS Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0-3 months before surgery (OR = 0.36, 95% CI 0.04-3.22), 0-6 months before surgery (OR = 0.69 95% CI 0.14-3.49) or any time before surgery (OR = 0.43, 95% CI 0.04-3.22). CONCLUSIONS Within the here investigated cohort, the risk of surgical site infections or wound healing problems following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously and is subject of further research. LEVEL OF EVIDENCE 2.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Orthopedics and Sports Medicine, Clinical Neurology
Language:English
Date:3 January 2018
Deposited On:15 Jan 2018 10:42
Last Modified:19 Aug 2018 12:55
Publisher:Lippincott Williams & Wilkins
ISSN:0362-2436
OA Status:Green
Publisher DOI:https://doi.org/10.1097/BRS.0000000000002542
PubMed ID:29300251

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