The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia Following ACDF

A Study of 245,754 Patients

Jourdan M. Cancienne, Brian C. Werner, Alex E. Loeb, Scott Yang, Hamid Hassanzadeh, Anuj Singla, Frank H. Shen, Adam L. Shimer

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective database analysis OBJECTIVE.: To compare rates of postoperative dysphagia, length of stay, infection and wound complications following short and long ACDF in patients who received local intraoperative steroids and those who did not. SUMMARY OF BACKGROUND DATA.: Only one prior small institutional study has investigated the application of local steroids at the time of ACDF to decrease postoperative dysphagia. METHODS.: A large administrative database was utilized to compare rates of postoperative dysphagia, length of stay, and infectious complications within 90 days in patients who received local steroid following short (1–2 level) and long (3 or more level) ACDF and control groups who did not. Non obtainable information within the database included type of steroid, application technique, outcome data, and incidence of miscoding and non-coding by physicians. Odds ratios (OR), 95% confidence intervals (CI) and P values were then calculated using SPSS. RESULTS.: The incidence of dysphagia was significantly lower (9.0% vs 14.6%, p?=?0.005) in patients who received local steroid in the long ACDF group (n?=?322) compared to a control group who did not (n?=?45,432). This was not observed (p?=?0.198) in the short ACDF group who received steroid (n?=?1,770) compared to a control group who did not (n?=?198,230). The mean difference in length of stay was 1 day less for patients who received local steroid in both the short and long ACDF groups (p?<?0.0001). The combined rate of postoperative infection and wound complications was not significantly different between steroid and control groups (p?=?0.717). CONCLUSIONS.: This analysis of a large administrative database suggests that local intraoperative steroid is associated with a significantly reduced rate of postoperative dysphagia after long ACDF and reduced average length of stay following both long and short ACDF without any increase in the rate of postoperative infection or wound complication.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Dec 14 2015

Fingerprint

Deglutition Disorders
Steroids
Length of Stay
Databases
Surgical Wound Infection
Control Groups
Incidence
Wound Infection
Odds Ratio
Confidence Intervals
Physicians

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia Following ACDF : A Study of 245,754 Patients. / Cancienne, Jourdan M.; Werner, Brian C.; Loeb, Alex E.; Yang, Scott; Hassanzadeh, Hamid; Singla, Anuj; Shen, Frank H.; Shimer, Adam L.

In: Spine, 14.12.2015.

Research output: Contribution to journalArticle

Cancienne, Jourdan M. ; Werner, Brian C. ; Loeb, Alex E. ; Yang, Scott ; Hassanzadeh, Hamid ; Singla, Anuj ; Shen, Frank H. ; Shimer, Adam L. / The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia Following ACDF : A Study of 245,754 Patients. In: Spine. 2015.
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title = "The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia Following ACDF: A Study of 245,754 Patients",
abstract = "STUDY DESIGN.: Retrospective database analysis OBJECTIVE.: To compare rates of postoperative dysphagia, length of stay, infection and wound complications following short and long ACDF in patients who received local intraoperative steroids and those who did not. SUMMARY OF BACKGROUND DATA.: Only one prior small institutional study has investigated the application of local steroids at the time of ACDF to decrease postoperative dysphagia. METHODS.: A large administrative database was utilized to compare rates of postoperative dysphagia, length of stay, and infectious complications within 90 days in patients who received local steroid following short (1–2 level) and long (3 or more level) ACDF and control groups who did not. Non obtainable information within the database included type of steroid, application technique, outcome data, and incidence of miscoding and non-coding by physicians. Odds ratios (OR), 95{\%} confidence intervals (CI) and P values were then calculated using SPSS. RESULTS.: The incidence of dysphagia was significantly lower (9.0{\%} vs 14.6{\%}, p?=?0.005) in patients who received local steroid in the long ACDF group (n?=?322) compared to a control group who did not (n?=?45,432). This was not observed (p?=?0.198) in the short ACDF group who received steroid (n?=?1,770) compared to a control group who did not (n?=?198,230). The mean difference in length of stay was 1 day less for patients who received local steroid in both the short and long ACDF groups (p?<?0.0001). The combined rate of postoperative infection and wound complications was not significantly different between steroid and control groups (p?=?0.717). CONCLUSIONS.: This analysis of a large administrative database suggests that local intraoperative steroid is associated with a significantly reduced rate of postoperative dysphagia after long ACDF and reduced average length of stay following both long and short ACDF without any increase in the rate of postoperative infection or wound complication.Level of Evidence: 3",
author = "Cancienne, {Jourdan M.} and Werner, {Brian C.} and Loeb, {Alex E.} and Scott Yang and Hamid Hassanzadeh and Anuj Singla and Shen, {Frank H.} and Shimer, {Adam L.}",
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T1 - The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia Following ACDF

T2 - A Study of 245,754 Patients

AU - Cancienne, Jourdan M.

AU - Werner, Brian C.

AU - Loeb, Alex E.

AU - Yang, Scott

AU - Hassanzadeh, Hamid

AU - Singla, Anuj

AU - Shen, Frank H.

AU - Shimer, Adam L.

PY - 2015/12/14

Y1 - 2015/12/14

N2 - STUDY DESIGN.: Retrospective database analysis OBJECTIVE.: To compare rates of postoperative dysphagia, length of stay, infection and wound complications following short and long ACDF in patients who received local intraoperative steroids and those who did not. SUMMARY OF BACKGROUND DATA.: Only one prior small institutional study has investigated the application of local steroids at the time of ACDF to decrease postoperative dysphagia. METHODS.: A large administrative database was utilized to compare rates of postoperative dysphagia, length of stay, and infectious complications within 90 days in patients who received local steroid following short (1–2 level) and long (3 or more level) ACDF and control groups who did not. Non obtainable information within the database included type of steroid, application technique, outcome data, and incidence of miscoding and non-coding by physicians. Odds ratios (OR), 95% confidence intervals (CI) and P values were then calculated using SPSS. RESULTS.: The incidence of dysphagia was significantly lower (9.0% vs 14.6%, p?=?0.005) in patients who received local steroid in the long ACDF group (n?=?322) compared to a control group who did not (n?=?45,432). This was not observed (p?=?0.198) in the short ACDF group who received steroid (n?=?1,770) compared to a control group who did not (n?=?198,230). The mean difference in length of stay was 1 day less for patients who received local steroid in both the short and long ACDF groups (p?<?0.0001). The combined rate of postoperative infection and wound complications was not significantly different between steroid and control groups (p?=?0.717). CONCLUSIONS.: This analysis of a large administrative database suggests that local intraoperative steroid is associated with a significantly reduced rate of postoperative dysphagia after long ACDF and reduced average length of stay following both long and short ACDF without any increase in the rate of postoperative infection or wound complication.Level of Evidence: 3

AB - STUDY DESIGN.: Retrospective database analysis OBJECTIVE.: To compare rates of postoperative dysphagia, length of stay, infection and wound complications following short and long ACDF in patients who received local intraoperative steroids and those who did not. SUMMARY OF BACKGROUND DATA.: Only one prior small institutional study has investigated the application of local steroids at the time of ACDF to decrease postoperative dysphagia. METHODS.: A large administrative database was utilized to compare rates of postoperative dysphagia, length of stay, and infectious complications within 90 days in patients who received local steroid following short (1–2 level) and long (3 or more level) ACDF and control groups who did not. Non obtainable information within the database included type of steroid, application technique, outcome data, and incidence of miscoding and non-coding by physicians. Odds ratios (OR), 95% confidence intervals (CI) and P values were then calculated using SPSS. RESULTS.: The incidence of dysphagia was significantly lower (9.0% vs 14.6%, p?=?0.005) in patients who received local steroid in the long ACDF group (n?=?322) compared to a control group who did not (n?=?45,432). This was not observed (p?=?0.198) in the short ACDF group who received steroid (n?=?1,770) compared to a control group who did not (n?=?198,230). The mean difference in length of stay was 1 day less for patients who received local steroid in both the short and long ACDF groups (p?<?0.0001). The combined rate of postoperative infection and wound complications was not significantly different between steroid and control groups (p?=?0.717). CONCLUSIONS.: This analysis of a large administrative database suggests that local intraoperative steroid is associated with a significantly reduced rate of postoperative dysphagia after long ACDF and reduced average length of stay following both long and short ACDF without any increase in the rate of postoperative infection or wound complication.Level of Evidence: 3

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