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Early preoperative steroid injection may lead to higher infection rates after cervical fusion

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SAN DIEGO — The timing of preoperative epidural steroid injection influenced 90-day postoperative infection rates after posterior cervical fusions, but did not have an effect on postoperative infection rates after anterior cervical discectomy and fusion, according to results of a study presented here that used a national database.

Patients who received an epidural steroid injection (ESI) 3 months prior to posterior cervical fusion experienced a 4% infection rate within 90 days of operation, almost double the 2.1% infection rate of a control group that underwent the surgery without a preoperative ESI, study co-author Jourdan M. Cancienne, MD, said at the Cervical Spine Research Society Annual Meeting.

“The present study suggests an increased risk of postoperative infection when cervical ESI is administered within 3 months prior to posterior cervical fusion. This association was not noted when posterior cervical fusion occurred more than 3 months after cervical ESI,” Cancienne said at the meeting.

Cancienne and colleagues used the national PearlDiver database to identify patients who underwent posterior cervical fusion or anterior cervical discectomy and fusion (ACDF) between 2005 and 2011. The researchers compared infection rates 90 days postoperatively in patients who received an ESI at various time intervals prior to their procedures. Patients were categorized into the following three groups: those who underwent surgery within 3 months of receiving an ESI; those who underwent a procedure within 3 months to 6 months of an ESI; and those who had surgery within 6 months to 12 months of an ESI. These groups were compared with control groups of patients who underwent either PCF or ACDF, but did not receive an ESI.

The only group that experienced a statistically significant increase in infection rates compared with controls was the cohort that underwent PCF within 3 months of an ESI. There were no significant differences in infection rates for the PCF or ACDF groups that had a preoperative ESI at any other time point when compared with control groups that did not receive an ESI, Cancienne said. – by Robert Linnehan

Reference:

Cancienne JM, et al. Presentation #36. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 3-5, 2015; San Diego.

Disclosure: Cancienne reports no relevant financial disclosures.