The association between preoperative epidural steroid injections and postoperative cervical and lumbar surgical site infections: A systematic review and meta-analysis.

Autor:	Sherwood D; University Health Lakewood Medical Center, Department of Orthopedics; Kansas City, MO, United States., Dovgan J; Vanderbilt University Medical Center, Physical Medicine and Rehabilitation Department; Nashville, TN, United States., Schirmer D; Stanford University Medical Center, Physical Medicine and Rehabilitation Division, Redwood City, CA, United States., Haring RS; Department of Pain Medicine, Southwell Medical, Tifton, GA, United States.; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States., Schneider B; Vanderbilt University Medical Center, Physical Medicine and Rehabilitation Department; Nashville, TN, United States.
Jazyk:	angličtina
Zdroj:	North American Spine Society journal [N Am Spine Soc J] 2024 Jun 05; Vol. 19, pp. 100334. Date of Electronic Publication: 2024 Jun 05 (Print Publication: 2024).
DOI:	10.1016/j.xnsj.2024.100334
Abstrakt:	Background: Is there a statistically significant association between preoperative epidural steroid injections (ESI) and postoperative cervical and lumbar spinal surgery infections (SSI)? Methods: A systematic review and meta-analysis was completed of patients 18 years or older who underwent elective cervical or lumbar spinal surgery. Those who underwent surgery with preoperative ESI were compared to those without. We assessed for differences in postoperative SSI incidence. Electronic literature databases were searched through October 2022. Peer-reviewed publications that included raw data regarding epidural exposure and non-exposure were included. Case reports, case series, abstracts, editorials, or publications that did not include raw data were excluded. Odd's ratios (OR) were calculated from the raw data collected. Meta-analysis was done using RevMan v5 with a fixed effects model. Results: We identified 16 articles for inclusion. When not controlling for the type of surgery and time from ESI to surgery, there was a statistically significant OR between preoperative ESI and postoperative SSI. The association persisted when the ESI was performed within 30 days or 31-90 days of the surgery. No association was discovered when evaluating only cervical spine surgeries. The evidence is assigned a "moderate" GRADE rating. Conclusions: Our analysis shows a small, time-dependent, statistically significant association between preoperative ESI and postoperative lumbar SSI may exist. However, the OR produced, while statistically significant, are close enough to 1.0 that clinically, the effect size is "small." The number needed to treat for an ESI in the appropriate clinical setting is, at worst, 3. The number needed to harm, meaning the number of patients who undergo an ESI at any time before their spine surgery and then develop a SSI, is 111 patients. Ultimately, the surgical sparing potential from an ESI outweighs the SSI risk based on our findings. Competing Interests: The authors declare no financial or professional conflicts of interests with regards to the contents of this manuscript. (© 2024 The Author(s).)
Databáze:	MEDLINE
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