Lumbar Decompression Surgery: Does Chronic Steroid Use Increase the Risk of Postoperative Infectious Complications? – A Study of the National Surgical Quality Improvement Program (NSQIP) Database

Intro: It has long been established that corticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Many past studies have shown that patient’s will have higher rates of infection if they are taking chronic steroids. What has yet to be established is just how much of an increased risk patients on chronic steroids have for infection after undergoing lumbar decompression surgeries, of which there are thousands per year. We hypothesize that patients on chronic steroids will have higher rates of surgical site infections and higher rates of other infections (UTI, pneumonia, etc.) after undergoing lumbar decompression surgery of the spine. Methods: To test our hypothesis, we looked at the ACS National Surgical Quality Improvement Program (NSQIP) database data from 2005-2014. Using CPT codes, we selected out all spine surgeries where the purpose of surgery was to decompress an area of the lumbar spine, including herniated discectomies, laminectomies, among others. Chi-square analysis was done to evaluate for differences among the steroid and non-steroid groups for demographics, preoperative comorbidities, and postoperative complications. Binary regression analysis was done to determine if chronic steroid use independently predicts rates of postoperative infections. Results: Though chronic steroid use was not found to increase rates of surgical site infections, chronic steroid use was found to independently predict rates of pneumonia (OR: 3.06, p=0.030) and septic shock (OR: 3.79, p=0.008). Discussion: While steroid use has been established as immunosuppressive, it has not been established to what extent steroid use increases infection rates postoperatively in lumbar decompression surgeries, of which there are thousands each year. Spine surgeons should remain vigilant regarding postoperative infections in patients on chronic steroids, especially as it relates to pneumonia and propensity to decompensate into septic shock as these occur at significantly higher rates than the general population