Preoperative epidural spinal injections increase the risk of surgical wound complications but do not affect overall complication risk or patient-perceived outcomes

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>A lack of information exists on the relationship between preoperative epidural spinal injections and outcomes after spine surgery. There is concern that injections might cause local changes, increasing the infection risk and surgical difficulty. Therefore, the authors explored the relationship between preoperative spinal injections and postoperative outcome.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The cohort was comprised of patients who underwent thoracic and/or lumbar arthrodesis during the years 2007–2010 and had complete (preoperatively and 3 months postoperatively) outcome scores. Patients’ clinical courses were reviewed to determine the occurrence of major complications within a 30-day postoperative period. Patient-perceived outcomes were evaluated using the Oswestry Disability Index (ODI) and the SF-12 (12-Item Short Form Health Survey): mental component summary (MCS) and physical component summary (PCS) scores. Analyses were based on exposure to injections and were performed using chi-square exact tests and paired and unpaired t-tests.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Two hundred eighty patients met the inclusion criteria: 117 patients (41.8%) received and 163 patients (58.2%) did not receive preoperative epidural spinal injections. Overall, the likelihood of complication did not differ with respect to exposure (13.7% injection vs 11.7% noninjection); however, injected patients observed a 7.4-fold risk of developing surgical wound complications over noninjected patients (5.1% vs 0.6%, p = 0.02).</jats:p> <jats:p>Patient-perceived outcomes measures demonstrated no differences between groups. Three months postoperatively, the MCS and ODI scores were similar (MCS: 49.6 ± 11.6 injection vs 47.4 ± 12.8 noninjection; ODI: 35.8 ± 18.0 vs 34.4 ± 19.1). MCS or ODI score improvement (preoperatively compared with 3 months postoperatively) did not vary between groups. Injected patients maintained a 2-point lower PCS score at entry and 3 months postoperatively as compared with noninjected peers (entry: 27.6 ± 8.2 injection vs 29.5 ± 9.3 noninjection, p = 0.09; 3 months: 33.3 ± 8.6 vs 35.7 ± 9.0, p = 0.03); the PCS score improvements between injected and noninjected groups were similar (5.7 ± 9.9 vs 6.2 ± 9.7).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients exposed to preoperative epidural injections had similar complication rates to those who never received a spinal injection. However, they had a greater risk of developing wound complications. These complications had no effect on short-term improvements in outcome measures.</jats:p></jats:sec>

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

“…The surgical outcomes and overall complication rates were reported to be similar for both groups, except that there was a 7.4-fold higher risk of surgical site infection in patients who received injections (5.1% for patients who received epidural injections vs 0.6% for those who did not). 36 Our study also suggests higher infection rates of 3.9% (66 of 1699) in patients receiving LESI within 1 month and 2.2% (120 of 5491) in patients receiving LESI within 1-3 months of surgery. The infection rates in our study are slightly lower than those reported by Zusman et al, but our results suggest a similar trend of increased risk of infection after injections in a much larger study population.…”

“…34 The infection rates we documented in the current study follow a similar trend, with higher rates of infection after injections performed closer to the time of surgery. Zusman et al 36 suggested the possibility of an increased risk of postoperative infection after lumbar fusion in patients who received preoperative epidural injections. Their study compared the surgical outcomes of lumbar fusion in patients with a history of epidural injections (117 patients) with those in patients who did not receive epidural injections (163 patients).…”

“…Recent studies have suggested a higher incidence of postoperative infection in patients who undergo lumbar spinal surgeries after preoperatively administered epidural injections. 34,36 The goal of the present study was to use a large national database to analyze the association between preoperative LESIs administered at various time intervals before lumbar spinal fusion and the incidence of surgical site infection.…”

An epidural steroid injection in the 6 months preceding a lumbar decompression without fusion predisposes patients to post-operative infections

“…This group also suggests the glucocorticoids prevent the natural host response to tissue injury and pathogen exposure, which leads to increased susceptibility to infection (12). It is also proposed that epidural injections can lead to epidural scarring, increased vascularization and promotion of degenerative changes at the injection site, which can potentially complicate the surgical site also (22). These multifactorial concerns all may contribute to the increased risk of surgical site infection.…”

The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis

“…Given the significant morbidity and cost associated with postoperative infection, these studies have strongly recommended against the administration of CSIs within 3 months of operative treatment. [28][29][30][31][32] However, many of these studies are case reports or case series that fail to reach the adequate number of patients necessary to draw definitive conclusions, which is a source of controversy.…”