P63. Influence of perioperative steroid use on surgical revision and infection rates following posterior lumbar fusion

PURPOSE This retrospective analysis sought to examine the relationship between perioperative steroid utilization and the rates of revision surgery and postoperative infection in subjects undergoing posterior lumbar spinal fusion surgery. STUDY DESIGN/SETTING Retrospective review of a prospectively maintained database. METHODS The M151Ortho PearlDiver database, which includes over 150,000,000 subjects undergoing orthopedic care from 2010 to 2021 was queried. CPT and ICD codes were used to identify subjects who underwent posterior lumbar fusion during the period of 2010-2016 with a 5-year followup period. Subjects who underwent a minimum of 3 months of prescription steroid treatment prior to and after surgery were further isolated as the study group. Demographic information was recorded, and an appropriately matched control cohort of subjects not treated with steroids was created. The rates of revision surgery and surgical site infection were compared between the two groups over the subsequent 5 years. RESULTS A total of 237,316 subjects were identified that had lumbar fusion surgery, which were then matched into two groups of subjects; one group which had concomitant steroid treatment within three months before and after surgery, and one group which did not have steroid treatment. After creating the matched cohort there were 5,628 matched subjects in each group. Within the first five years following the primary surgery, the overall revision rate of posterior lumbar fusion in the 237,316 subjects queried was 7.13% (n = 16,927). Subjects treated with steroids had a 7.9% revision rate versus a 6.6% revision rate in the group not treated with steroids, which was statistically significant (OR = 1.21, p = 0.01). Infection rates in steroid-treated subjects was 4.8%, compared to a 4.1% infection rate in subjects not treated with steroids, which was also statistically significant (OR = 0.82, p = 0.04). The percentage of subjects with infection that did not require revision was not statistically significant between the subjects treated with steroids and the subjects not treated with steroids (p = 0.89). CONCLUSIONS This retrospective analysis of a prospectively maintained database demonstrated that steroids are associated with increased rates of revision surgery and infection in subjects undergoing posterior lumbar spine fusion surgery. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. This retrospective analysis sought to examine the relationship between perioperative steroid utilization and the rates of revision surgery and postoperative infection in subjects undergoing posterior lumbar spinal fusion surgery. Retrospective review of a prospectively maintained database. The M151Ortho PearlDiver database, which includes over 150,000,000 subjects undergoing orthopedic care from 2010 to 2021 was queried. CPT and ICD codes were used to identify subjects who underwent posterior lumbar fusion during the period of 2010-2016 with a 5-year followup period. Subjects who underwent a minimum of 3 months of prescription steroid treatment prior to and after surgery were further isolated as the study group. Demographic information was recorded, and an appropriately matched control cohort of subjects not treated with steroids was created. The rates of revision surgery and surgical site infection were compared between the two groups over the subsequent 5 years. A total of 237,316 subjects were identified that had lumbar fusion surgery, which were then matched into two groups of subjects; one group which had concomitant steroid treatment within three months before and after surgery, and one group which did not have steroid treatment. After creating the matched cohort there were 5,628 matched subjects in each group. Within the first five years following the primary surgery, the overall revision rate of posterior lumbar fusion in the 237,316 subjects queried was 7.13% (n = 16,927). Subjects treated with steroids had a 7.9% revision rate versus a 6.6% revision rate in the group not treated with steroids, which was statistically significant (OR = 1.21, p = 0.01). Infection rates in steroid-treated subjects was 4.8%, compared to a 4.1% infection rate in subjects not treated with steroids, which was also statistically significant (OR = 0.82, p = 0.04). The percentage of subjects with infection that did not require revision was not statistically significant between the subjects treated with steroids and the subjects not treated with steroids (p = 0.89). This retrospective analysis of a prospectively maintained database demonstrated that steroids are associated with increased rates of revision surgery and infection in subjects undergoing posterior lumbar spine fusion surgery.