Impact of Intraoperative Steroids on Postoperative Infection Rates and Length of Hospital Stay: A Study of 1200 Spine Surgery Patients.
OBJECTIVE
The use of intraoperative steroids and their effects are relatively unknown and remain controversial. The aim of this study was to determine the effects of intraoperative steroid use on postoperative complications and length of hospital stay after spine surgery.


METHODS
Medical records of 1200 adult patients undergoing spine surgery at Duke University Medical Center during the period 2008-2010 were retrospectively reviewed; 495 (41.25%) patients were administered intraoperative steroids, and 705 (58.75%) patients were not administered intraoperative steroids. Patient demographics, comorbidities, and postoperative complication rates were collected. The primary outcomes investigated were postoperative complications, specifically length of hospital stay and infection rates.


RESULTS
Patient demographics were similar between both cohorts. Comorbidities were also similar, with the intraoperative steroid use cohort having a higher number of patients with long-term steroid use than the no intraoperative steroid use cohort (6.95% [no steroids] vs. 13.74% [steroid use], P < 0.001). Operative variables, including length of operation and median number of fusion levels operated, were also similar between the 2 groups. Lumbar spine was the most common surgical location. Patients who were administered intraoperative steroids had a shorter length of hospital stay by an average of 1 day (6.06 days ± 6.76 [no steroids] vs. 5.04 days ± 4.86 [steroid use], P = 0.0025), lower rates of urinary tract infections (10.37% [no steroids] vs. 6.88% [steroid use], P = 0.040), and lower rates of other infections that were not deep or superficial surgical site infections (9.22% [no steroids] vs. 6.06% [steroid use], P = 0.0460).


CONCLUSIONS
Patients who receive intraoperative steroids have shorter hospital stays and lower infection rates after spine surgery.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Aladine A
AA
Elsamadicy
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Timothy Y
TY
Wang
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Adam G
AG
Back
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Amanda
A
Sergesketter
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Hunter
H
Warwick
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Isaac O
IO
Karikari
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: oren.gottfried@duke.edu.
Oren N
ON
Gottfried
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control*; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D018709:Statistics, Nonparametric; D013256:Steroids / Q000627:therapeutic use*
D013256:Steroids
Complication rates; Infection rate; Intraoperative steroids; Length of hospital stay; Spine surgery