Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA.
Spine (Phila Pa 1976). 2021 Feb 1;46(3):E197-E202. doi: 10.1097/BRS.0000000000003759.
Retrospective study.
To elucidate an association between preoperative lumbar epidural corticosteroid injections (ESI) and infection after lumbar spine surgery.
ESI may provide diagnostic and therapeutic benefit; however, concern exists regarding whether preoperative ESI may increase risk of postoperative infection.
Patients who underwent lumbar decompression alone or fusion procedures for radiculopathy or stenosis between 2000 and 2017 with 90 days follow-up were identified by ICD/CPT codes. Each cohort was categorized as no preoperative ESI, less than 30 days, 30 to 90 days, and greater than 90 days before surgery. The primary outcome measure was postoperative infection requiring reoperation within 90 days of index procedure. Demographic information including age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI) was determined. Comparison and regression analysis was performed to determine an association between preoperative ESI exposure, demographics/comorbidities, and postoperative infection.
A total of 15,011 patients were included, 5108 underwent fusion and 9903 decompression only. The infection rate was 1.95% and 0.98%, among fusion and decompression patients, respectively. There was no association between infection and preoperative ESI exposure at any time point (1.0%, P = 0.853), ESI within 30 days (1.37%, P = 0.367), ESI within 30 to 90 days (0.63%, P = 0.257), or ESI > 90 days (1.3%, P = 0.277) before decompression surgery. There was increased risk of infection in those patients undergoing preoperative ESI before fusion compared to those without (2.68% vs. 1.69%, P = 0.025). There was also increased risk of infection with an ESI within 30 days of surgery (5.74%, P = 0.005) and when given > 90 days (2.9%, P = 0.022) before surgery. Regression analysis of all patients demonstrated that fusion (P < 0.001), BMI (P < 0.001), and CCI (P = 0.019) were independent predictors of postoperative infection, while age, sex, and preoperative ESI exposure were not.
An increased risk of infection was found in patients with preoperative ESI undergoing fusion procedures, but no increased risk with decompression only. Fusion, BMI, and CCI were predictors of postoperative infection.Level of Evidence: 3.
回顾性研究。
阐明术前腰椎硬膜外皮质类固醇注射（ESI）与腰椎手术后感染之间的关联。
ESI 可能提供诊断和治疗益处；然而，人们担心术前 ESI 是否会增加术后感染的风险。
通过 ICD/CPT 代码确定 2000 年至 2017 年间接受腰椎减压术或融合术治疗神经根病或狭窄症且随访 90 天的患者。每个队列分为无术前 ESI、术前 ESI 少于 30 天、术前 ESI 30 至 90 天和术前 ESI 超过 90 天。主要观察指标为索引手术后 90 天内需要再次手术的术后感染。确定人口统计学信息，包括年龄、性别、体重指数（BMI）、Charlson 合并症指数（CCI）。进行比较和回归分析以确定术前 ESI 暴露、人口统计学/合并症与术后感染之间的关联。
共纳入 15011 例患者，其中 5108 例接受融合术，9903 例仅接受减压术。融合和减压患者的感染率分别为 1.95%和 0.98%。在任何时间点（1.0%，P=0.853）、术前 ESI 少于 30 天（1.37%，P=0.367）、术前 ESI 30 至 90 天（0.63%，P=0.257）或术前 ESI 超过 90 天（1.3%，P=0.277），术前 ESI 暴露与感染均无关联。与未接受术前 ESI 的患者相比，术前接受 ESI 的融合患者感染风险增加（2.68%比 1.69%，P=0.025）。术前 ESI 术后 30 天内（5.74%，P=0.005）和术后 90 天以上（2.9%，P=0.022）给予 ESI 的感染风险也增加。对所有患者进行回归分析表明，融合（P<0.001）、BMI（P<0.001）和 CCI（P=0.019）是术后感染的独立预测因素，而年龄、性别和术前 ESI 暴露则不是。
发现术前接受 ESI 的融合患者感染风险增加，但仅减压患者无此风险。融合、BMI 和 CCI 是术后感染的预测因素。
3 级。
