Elsevier

World Neurosurgery

Volume 96, December 2016, Pages 429-433
World Neurosurgery

Original Article
Impact of Intraoperative Steroids on Postoperative Infection Rates and Length of Hospital Stay: A Study of 1200 Spine Surgery Patients

https://doi.org/10.1016/j.wneu.2016.09.057Get rights and content

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.

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.

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