Use of Dexamethasone in the Immediate Postoperative Period Is Associated With Increased Risk of Instrumentation and Surgical Site Complications in Diabetic Patients Undergoing Lumbar Spinal Fusion.

Abstract

Retrospective database study. To evaluate whether dexamethasone utilized in the immediate postoperative setting after 1- or 2-level posterior lumbar spinal fusion (PLSF) leads to an increased rate of wound and instrumentation complications in the diabetic population. Dexamethasone is widely utilized in the postoperative setting in patients undergoing PLSF for pain control and/or persistent radiculopathy. There is a paucity of literature evaluating the effects of dexamethasone in the diabetic population, who are more prone to postoperative surgical site infections (SSIs) and instrumentation complications. Patients undergoing 1- or 2-level PLSF with a diagnosis of type II diabetes mellitus who received dexamethasone within 3 days postoperatively were retrospectively identified using the PearlDiver database. Diabetic patients receiving dexamethasone were propensity-matched in a 1:10 ratio to diabetic patients undergoing the same procedure who did not receive dexamethasone. SSIs, instrumentation complications, and medical complications were assessed at 30 days, 90 days, and 1 year. A total of 7865 were included in this study. The test group consisted of 715 patients who received dexamethasone, and the control group included 7150 patients who did not receive dexamethasone. SSIs were significantly elevated in the test group at 30 days [OR=1.51 (1.01-2.13), P=0.019], 90 days [OR=1.38 (1.00-1.91), P=0.047], and 1 year [OR=1.36 (1.01-1.84), P=0.046]. Instrumentation complications were also significantly elevated in the test group at all time points: 30 days [OR=2.0 (1.16-3.43), P=0.012], 90 days [OR=2.18 (1.45-3.28), P<0.001], and 1 year [OR=1.63 (1.22-2.19), P=0.001]. Administration of dexamethasone in the postoperative period after 1- or 2-level PLSF may be associated with a higher risk of SSI and instrumentation complications at 30 days, 90 days, and 1 year in diabetic patients undergoing elective 1- or 2-level lumbar fusion.