Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: spinal deformity analysis: 222. The effects of chronic preoperative steroid therapy on perioperative complications following elective surgery for adult spinal deformity

Abstract

BACKGROUND CONTEXT Chronic steroid therapy is widely utilized in the treatment of various inflammatory and autoimmune conditions. Despite their demonstrated therapeutic value, steroids are known to be associated with adverse effects. There remains a gap in the literature regarding the role of chronic steroid therapy in predisposing patients to perioperative complications following elective surgery for Adult Spinal Deformity (ASD). PURPOSE This study aims to identify the effects of chronic preoperative steroid therapy on 30-day perioperative complications in patients undergoing surgery for ASD. STUDY DESIGN/SETTING Retrospective Cohort Study. PATIENT SAMPLE A retrospective analysis was performed on data from 2011 to 2014 ACS-NSQIP database for patient undergoing corrective surgery for Adult Spinal Deformity. OUTCOME MEASURES Preoperative chronic steroid use was analyzed for any correlation with perioperative complications. METHODS A retrospective analysis was performed on data from 2011 to 2014 ACS-NSQIP database. Univariate analysis was used to assess patient baseline characteristics, comorbidities and perioperative outcomes. Multivariate stepwise logistic regression models were employed, adjusting for patient demographic, preoperative and patient comorbidities, to identify associations between preoperative chronic steroid use and postoperative complications. RESULTS We identified 7,936 patients who underwent elective ALF, 418 patients received chronic preoperative steroid therapy. Chronic preoperative steroid therapy was an independent risk factor for six perioperative complications, including mortality (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.63–5.74; P=.0004), length of stay ≥ 5 days (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.17–2.07; P= CONCLUSIONS Patients on chronic preoperative steroid therapy are at increased risk of mortality along with multiple perioperative complications following elective surgery for ASD. Interdisciplinary management of perioperative steroid regimens with the goal of reducing or holding preoperative steroids is critical in order to reduce steroid-associated surgical complications.