Introduction: The effects and use of intra-operative steroids is relatively unknown and remains controversial. There have been conflicting studies demonstrating the efficacy of intraoperative steroids on post-operative dysphagia and inflammation; while others demonstrate no improvement in outcomes. The aim of this is to determine if the use of intra-operative steroid effect post-operative complications and length of hospital stay after spine surgery.
Methods: The medical records of 1200 adult (=18 years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were retrospectively reviewed. There were 495 (41.25%) patients who were administered intra-operative steroids, and 705 (58.75%) who were not (No-Steroid: n=705; Steroid: n=495). Patient demographics, comorbidities, and post-operative complication rates were collected on each patient. The primary outcomes investigated in this study were post-operative complications, specifically length of hospital stay and infection rates.
Results: Patient demographics were similar between both cohorts, Table 1. The comorbidities were similar between the groups, with intra-operative steroid use cohort having a higher number of chronic steroid users than the non-intra-operative steroid cohort (No-Steroid: 6.95 vs. Steroid: 13.74, p=0.0002),Table 1. Operative variables including length of operation and median number of fusion levels operated were also similar between both groups,Table 2. Lumbar region was the most common surgical location,Table 2. Patients who were administered intra-operative steroids had a shorter length of hospital stay by an average of one day (No-Steroid: 6.06±6.76 days vs. Steroid: 5.04±4.86 days, p=0.0025), lower rates of urinary tract infections (No-Steroid: 10.37% vs. Steroid: 6.88%, p=0.0397) and other infection rates that were not deep or superficial surgical site infections (No-Steroid: 9.22% vs. Steroid: 6.06%, p=0.0460),Table 3.
Conclusions: Our study demonstrates that patients who receive intra-operative steroids have lower length of hospital days and infection rates after spine surgery. More studies are necessary to further understand the efficacy of intra-operative steroid use.
Patient Care: Our research helps demonstrate utility in intraoperative steroid use in reducing post-operative infections and length of hospital stay.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of the use of intraoperative steroids on infection rates and length of hospital stay.
2) Discuss, in small groups why intraoperative steroids reduces post-operative infection rates and length of hospital stay.