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Abstract：
Objective Spinal fusions are gaining popularity as a means of treating spinal deformity and instability from a range of pathologies. The prevalence of glucocorticoid use has also increased in recent decades, and their systemic effects are well-documented. Although commonly used in the preoperative period, the effects of steroids on outcomes among patients undergoing spinal fusions are inadequately described. This study compares the odds of developing complications among patients who underwent single-level lumbar fusions with and without preoperative glucocorticoid use in hopes of establishing more evidence-based parameters for guiding preoperative steroid use. Methods The TriNetX multi-institutional electronic health record database was used to perform a retrospective, propensity score-matched analysis of clinical outcomes of two cohorts of patients who underwent posterior or posterolateral single-level lumbar fusions with and without interbody fusion, those who used glucocorticoids for at least one week within a year of fusion and those who did not. The outcomes of interest were examined within 30 days of the operation and included death, reoperation, deep or superficial surgical site infection (SSI), pneumonia, reintubation, ventilator dependence, tracheostomy, acute kidney injury (AKI), renal insufficiency, pulmonary embolism (PE) or deep venous thrombosis (DVT), urinary tract infection (UTI), emergency department (ED) visit, sepsis, and myocardial infarction (MI). Results The odds of developing pneumonia within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.67 (p≤0.001, 95% CI: 0.59-0.69). The odds of requiring a tracheostomy within 30 days of spinal fusion in the cohort that used glucocorticoids within one year of operation compared to the cohort without glucocorticoid use was 0.39 (p≤0.001, 95% CI: 0.26-0.60). The odds of reoperation, deep and superficial SSI, and ED visits within 30 days of operation were significantly higher for the same glucocorticoid-receiving cohort, with odds ratios of 1.4 (p=0.003, 95% CI: 1.11-1.65), 1.86 (p≤0.001, 95% CI: 1.31-2.63), 2.28 (p≤0.001, 95% CI: 1.57-3.31), and 1.25 (p≤0.001, 95% CI: 1.17-1.33), respectively. After propensity score-matching, there was no significant difference between the odds of death, DVT, PE, MI, UTI, AKI, sepsis, reintubation, and ventilator dependence between the two cohorts. Conclusion In support of much of the current literature regarding preoperative glucocorticoid use and rates of complications, patients who underwent a single-level lumbar fusion and have used glucocorticoids for at least a week within a year of operation experienced significantly higher odds of reoperation, deep and superficial SSI, and ED visits. However, these patients using glucocorticoids were also found to have lower odds of developing pneumonia, renal insufficiency, and tracheostomy requirement than those who did not use steroids within a year of surgery.
摘要：
目的脊柱融合术作为一种治疗脊柱畸形和不稳定的方法，从一系列的病理中越来越受欢迎。近几十年来，糖皮质激素的使用也有所增加，它们的系统性影响是有据可查的。虽然常用于术前，类固醇对脊柱融合患者结局的影响描述不充分.这项研究比较了在术前使用和不使用糖皮质激素的情况下进行单级腰椎融合的患者发生并发症的几率，以期建立更多基于证据的参数来指导术前类固醇的使用。方法采用TriNetX多机构电子健康档案数据库进行回顾性分析,倾向评分匹配的两组患者的临床结局分析，这些患者接受有和没有椎间融合的后外侧或后外侧单级腰椎融合，那些在融合后一年内使用糖皮质激素至少一周的人和那些没有使用糖皮质激素的人。在手术后30天内检查了感兴趣的结果，包括死亡，再操作,深部或浅表手术部位感染（SSI），肺炎,再插管,呼吸机依赖，气管造口术,急性肾损伤(AKI),肾功能不全,肺栓塞（PE）或深静脉血栓形成（DVT），尿路感染（UTI），急诊科（ED）访问，脓毒症,心肌梗死（MI）。结果与未使用糖皮质激素的队列相比，在手术后一年内使用糖皮质激素的队列在脊柱融合术后30天内发生肺炎的几率为0.67（p≤0.001，95％CI：0.59-0.69）。与未使用糖皮质激素的队列相比，在手术后一年内使用糖皮质激素的队列在脊柱融合术后30天内需要气管造口术的几率为0.39（p≤0.001，95％CI：0.26-0.60）。再次手术的可能性，深层和表面的SSI，对于相同的糖皮质激素接受队列，手术后30天内的ED访视明显更高，比值比为1.4(p=0.003，95%CI：1.11-1.65)，1.86（p≤0.001，95%CI：1.31-2.63），2.28（p≤0.001，95%CI：1.57-3.31），和1.25（p≤0.001，95%CI：1.17-1.33），分别。在倾向得分匹配后，死亡几率之间没有显着差异，DVT,PE,MI,UTI,AKI,脓毒症,再插管,两个队列之间的呼吸机依赖性。结论支持许多关于术前糖皮质激素使用和并发症发生率的现有文献，接受单级腰椎融合术并在一年内使用糖皮质激素至少一周的患者再次手术的几率明显更高。深层和表面的SSI，ED访问。然而,这些使用糖皮质激素的患者也被发现患肺炎的几率较低，肾功能不全,和气管造口术的要求比那些在一年内没有使用类固醇的人手术。
