دورية أكاديمية
أعرض في EDS

Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study.

التفاصيل البيبلوغرافية
العنوان: Effects of Preoperative Glucocorticoid Use on Patients Undergoing Single-Level Lumbar Fusions: A Retrospective Propensity Score-Matched Registry Study.
المؤلفون: Stoltzfus MT; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA., Nguyen K; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA., Freedman Z; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA., Hallan DR; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA., Hong J; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA., Rizk E; Department of Neurosurgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.
المصدر: Cureus [Cureus] 2024 Mar 29; Vol. 16 (3), pp. e57197. Date of Electronic Publication: 2024 Mar 29 (Print Publication: 2024).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: Palo Alto, CA : Cureus, Inc.
مستخلص: Objective Spinal fusions are gaining popularity as a means of treating spinal deformity and instability from a range of pathologies. The prevalence of glucocorticoid use has also increased in recent decades, and their systemic effects are well-documented. Although commonly used in the preoperative period, the effects of steroids on outcomes among patients undergoing spinal fusions are inadequately described. This study compares the odds of developing complications among patients who underwent single-level lumbar fusions with and without preoperative glucocorticoid use in hopes of establishing more evidence-based parameters for guiding preoperative steroid use. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective, propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent posterior or posterolateral single-level lumbar fusions with and without interbody fusion, those who used glucocorticoids for at least one week within a year of fusion and those who did not. The outcomes of interest were examined within 30 days of the operation and included death, reoperation, deep or superficial surgical site infection (SSI), pneumonia, reintubation, ventilator dependence, tracheostomy, acute kidney injury (AKI), renal insufficiency, pulmonary embolism (PE) or deep venous thrombosis (DVT), urinary tract infection (UTI), emergency department (ED) visit, sepsis, and myocardial infarction (MI). Results The odds of developing pneumonia within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.67 (p≤0.001, 95% CI: 0.59-0.69). The odds of requiring a tracheostomy within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.39 (p≤0.001, 95% CI: 0.26-0.60). The odds of reoperation, deep and superficial SSI, and ED visits within 30 days of operation were significantly higher for the same glucocorticoid-receiving cohort, with odds ratios of 1.4 (p=0.003, 95% CI: 1.11-1.65), 1.86 (p≤0.001, 95% CI: 1.31-2.63), 2.28 (p≤0.001, 95% CI: 1.57-3.31), and 1.25 (p≤0.001, 95% CI: 1.17-1.33), respectively. After propensity score-matching, there was no significant difference between the odds of death, DVT, PE, MI, UTI, AKI, sepsis, reintubation, and ventilator dependence between the two cohorts. Conclusion In support of much of the current literature regarding preoperative glucocorticoid use and rates of complications, patients who underwent a single-level lumbar fusion and have used glucocorticoids for at least a week within a year of operation experienced significantly higher odds of reoperation, deep and superficial SSI, and ED visits. However, these patients using glucocorticoids were also found to have lower odds of developing pneumonia, renal insufficiency, and tracheostomy requirement than those who did not use steroids within a year of surgery.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2024, Stoltzfus et al.)
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فهرسة مساهمة: Keywords: nosocomial pneumonia; preoperative glucocorticoids; renal insufficiency; sepsis; spinal fusion surgery; surgical complication; surgical site infection(ssi); surgical tracheostomy; thromboembolic event; unplanned reoperation
تواريخ الأحداث: Date Created: 20240429 Latest Revision: 20240430
رمز التحديث: 20240430
مُعرف محوري في PubMed: PMC11056191
DOI: 10.7759/cureus.57197
PMID: 38681464
قاعدة البيانات: MEDLINE
الوصف
تدمد:2168-8184
DOI:10.7759/cureus.57197