The Effects of Preoperative Steroid Therapy on Perioperative Complications After Elective Anterior Lumbar Fusion

Abstract

To examine the effects of chronic preoperative steroid therapy on 30-day perioperative complications after anterior lumbar fusion (ALF). We retrospectively analyzed data from the American College of Surgeons National Surgical Quality Improvement Program between 2008 and 2015. Adult patients who underwent ALF were included and divided into 2 groups: steroids and no steroids. We compared baseline patient demographics, comorbidities, and operative variables between these 2 groups and then performed a multivariate regression analysis to determine complications that were independently associated with chronic steroid therapy. We also performed a subgroup analysis of the steroid group to identify additional risk factors that further predispose these patients to postoperative complications. A total of 9483 patients were included, of whom 289 (3.0%) were on chronic steroid therapy. Univariate analysis showed that chronic steroid use was independently associated with 4 perioperative complications, including deep surgical site infection (odds ratio [OR], 2.78; confidence interval [CI], 1.09-7.10; P= 0.033), pulmonary complications (OR, 1.98; CI, 1.02-3.86; P= 0.044), blood transfusion (OR, 1.60; CI, 1.15-2.23; P= 0.005), and extended length of stay (OR, 1.58; CI, 1.17-2.16; P= 0.003). In patients on chronic steroid therapy, pulmonary comorbidity and extended operative time were additional risk factors that further predisposed to perioperative complications, including deep surgical site infection, blood transfusion, and extended length of stay. Chronic preoperative steroid therapy is associated with perioperative complications after ALF. Decisions about the discontinuing or holding steroid therapy preoperatively should be determined through an interdisciplinary approach between the medical and surgical teams.