Is There an Association of Epidural Corticosteroid Injection With Postoperative Surgical Site Infection After Surgery for Lumbar Degenerative Spine Disease?
METHODS
Retrospective study.


OBJECTIVE
To assess the relation between exposure to epidural steroid injection (ESI) before surgery and occurrence of surgical site infection (SSI) for degenerative lumbar spine conditions.


BACKGROUND
The effect of local ESI on the occurrence of SSI is controversial.


METHODS
Patients who underwent surgery for degenerative lumbar spine conditions at two centers between 2005 and 2015 were identified. Primary outcome measure was SSI within 90 days requiring surgical intervention.


RESULTS
A total of 5311 patients (age 57 ± 16 years) were analyzed of which 945 (18%) had at least one ESI within 90 days of surgery. One hundred thirty-four (2.5%) patients developed an SSI requiring reoperation. No association of exposure or dose-response relationship was identified between ESI and SSI for any of the time periods (90-, 30-, and 30-90-day). Five (1.7%) of the 290 patients who had at least one ESI within 30 days before surgery had a postoperative infection compared to 129 (2.6%) of the 5021 in the non-ESI group (unadjusted odds ratio: 0.67, 95% CI: 0.27-1.64, P = 0.376). Fifteen (2.0%) of the 761 patients who had at least one ESI within 30 to 90 days before surgery had a postoperative infection, compared to 119 (2.6%) of the 4550 in the non-ESI group (unadjusted odds ratio: 0.75, 95% CI: 0.44-1.29, P = 0.296).


CONCLUSIONS
In this retrospective study we investigated whether an ESI and its timing influences the postoperative risk of an SSI. We found no association-exposure or dose-response relationship-between ESI and postoperative infection, even after adjusting for potential confounders, for any of the time periods (90-, 30-, and 30-90-day ESI). In addition, we did find that longer hospital stay, greater EBL, posterior approach, and drain placement were associated with higher infection rates.Level of Evidence: 3.
Stefan
S
Hartveldt
Department of Orthopedic Surgery, Orthopedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Stein J
SJ
Janssen
Department of Orthopedic Surgery, Orthopedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Kirkham B
KB
Wood
Department of Orthopedic Surgery, Orthopedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Thomas D
TD
Cha
Department of Orthopedic Surgery, Orthopedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Joseph H
JH
Schwab
Department of Orthopedic Surgery, Orthopedic Spine Service, Brigham and Women's Hospital-Harvard Medical School, Boston, MA.
Christopher M
CM
Bono
Department of Orthopedic Surgery, Orthopedic Spine Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Louis G
LG
Jenis
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