Original ArticleImpact of Intraoperative Steroids on Postoperative Infection Rates and Length of Hospital Stay: A Study of 1200 Spine Surgery Patients
Introduction
There has been an increasing national effort to reduce the rising health care costs in the United States by enhancing care while decreasing expenditures. In surgery, particularly, length of hospital stay (LOS) has gradually become a proxy for quality of care and is a quantifiable cost metric that hospitals use to value the financial bearing of surgical procedures.1, 2 Furthermore, increased postoperative complications have been associated with reduced quality of recovery and increased LOS.3, 4 Therefore, it is necessary to identify factors that reduce postoperative complications and hospital LOS to lessen the burden of soaring health care costs.
In spine surgery, the use of intraoperative steroids is a surgical variable that continues to be widely debated as a standard practice. There have been conflicting studies demonstrating the efficacy of intraoperative steroids on postoperative outcomes, with some studies indicating better quality in postoperative recovery. In a prospective, randomized double-blind study of 54 patients who underwent multilevel spine fusion, Bekker et al.3 demonstrated that patients receiving intraoperative steroids had significantly higher quality of recovery than patients not receiving steroids. However, the effects of intraoperative steroids on postoperative complications and hospital LOS after spine surgery are relatively unknown. The aim of this study was to determine if the use of intraoperative steroids affects postoperative complications and hospital LOS after spine surgery.
Section snippets
Materials and Methods
Institutional review board approval was obtained before study initiation. The medical records of 1200 adult (≥18 years old) 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 (no steroids cohort, n = 705; steroid use cohort, n = 495). The administered steroids were intravenous
Results
This study included 1200 adult (≥18 years old) patients (no steroids cohort, n = 705; steroid use cohort, n = 495). Patient demographics and preoperative comorbidities are listed in Table 1. A greater proportion of male patients were included in the no steroids cohort than in the steroid use cohort (P = 0.0005), whereas a greater proportion of female patients were included in the steroid use cohort compared with the no steroids cohort (P = 0.0005). There was no significant difference in age (P
Discussion
This retrospective analysis suggests that the use of intraoperative steroids in spinal operations results in shorter length of hospitalization and lower infection rates. Although the consensus of the effects intraoperative steroids have on postoperative complications and outcomes is unclear in spine surgery, some studies have found superior outcomes with the use of perioperative and intraoperative steroids. In a prospective, double-blinded, randomized controlled trial of 80 patients undergoing
Conclusions
This study suggests that patients who receive intraoperative steroids have lower LOS and infection rates after spine surgery. Further studies are necessary to understand the efficacy of intraoperative steroids on postoperative outcomes and the independent patient factors that may improve or worsen surgical outcomes.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.