The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

Anuj Singla, Scott Yang, Brian C. Werner, Jourdan M. Cancienne, Ali Nourbakhsh, Adam L. Shimer, Hamid Hassanzadeh, Francis H. Shen

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE: Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS: A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS: The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1-3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI. CONCLUSIONS: Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

Original languageEnglish (US)
Pages (from-to)645-649
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume26
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Epidural Injections
Steroids
Spinal Fusion
Infection
Surgical Wound Infection
Databases
Insurance
Current Procedural Terminology
Radiculopathy
Low Back Pain

Keywords

  • Epidural injection
  • Infection
  • Lumbar fusion
  • Postoperative complications
  • Spine surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Singla, A., Yang, S., Werner, B. C., Cancienne, J. M., Nourbakhsh, A., Shimer, A. L., ... Shen, F. H. (2017). The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery. Journal of Neurosurgery: Spine, 26(5), 645-649. https://doi.org/10.3171/2016.9.SPINE16484

The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery. / Singla, Anuj; Yang, Scott; Werner, Brian C.; Cancienne, Jourdan M.; Nourbakhsh, Ali; Shimer, Adam L.; Hassanzadeh, Hamid; Shen, Francis H.

In: Journal of Neurosurgery: Spine, Vol. 26, No. 5, 01.05.2017, p. 645-649.

Research output: Contribution to journalArticle

Singla, A, Yang, S, Werner, BC, Cancienne, JM, Nourbakhsh, A, Shimer, AL, Hassanzadeh, H & Shen, FH 2017, 'The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery', Journal of Neurosurgery: Spine, vol. 26, no. 5, pp. 645-649. https://doi.org/10.3171/2016.9.SPINE16484
Singla, Anuj ; Yang, Scott ; Werner, Brian C. ; Cancienne, Jourdan M. ; Nourbakhsh, Ali ; Shimer, Adam L. ; Hassanzadeh, Hamid ; Shen, Francis H. / The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 26, No. 5. pp. 645-649.
@article{6722c351fc524cc79e4173178695793e,
title = "The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery",
abstract = "OBJECTIVE: Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS: A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS: The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6{\%} (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1-3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI. CONCLUSIONS: Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.",
keywords = "Epidural injection, Infection, Lumbar fusion, Postoperative complications, Spine surgery",
author = "Anuj Singla and Scott Yang and Werner, {Brian C.} and Cancienne, {Jourdan M.} and Ali Nourbakhsh and Shimer, {Adam L.} and Hamid Hassanzadeh and Shen, {Francis H.}",
year = "2017",
month = "5",
day = "1",
doi = "10.3171/2016.9.SPINE16484",
language = "English (US)",
volume = "26",
pages = "645--649",
journal = "Journal of neurosurgery. Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery

AU - Singla, Anuj

AU - Yang, Scott

AU - Werner, Brian C.

AU - Cancienne, Jourdan M.

AU - Nourbakhsh, Ali

AU - Shimer, Adam L.

AU - Hassanzadeh, Hamid

AU - Shen, Francis H.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - OBJECTIVE: Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS: A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS: The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1-3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI. CONCLUSIONS: Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

AB - OBJECTIVE: Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS: A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS: The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1-3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI. CONCLUSIONS: Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar fusion was performed more than 3 months after LESI.

KW - Epidural injection

KW - Infection

KW - Lumbar fusion

KW - Postoperative complications

KW - Spine surgery

UR - http://www.scopus.com/inward/record.url?scp=85019707798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019707798&partnerID=8YFLogxK

U2 - 10.3171/2016.9.SPINE16484

DO - 10.3171/2016.9.SPINE16484

M3 - Article

VL - 26

SP - 645

EP - 649

JO - Journal of neurosurgery. Spine

JF - Journal of neurosurgery. Spine

SN - 1547-5654

IS - 5

ER -