Outcomes Associated With Postoperative Dexamethasone Use After Adult Spinal Deformity Surgery

Objective: Dexamethasone is commonly prescribed following adult spinal deformity (ASD) surgery; however, dexamethasone’s immunosuppressive effects on clinical outcomes in ASD surgery remain unclear. This study sought to: assess the effects of postoperative dexamethasone after ASD surgery, and evaluate the potential association between postoperative dexamethasone and complications.Methods: This TriNetX study identified adults who underwent ASD surgery from 2009–2024. Outcomes were explored at 30-day, 90-day, and 1-year time points among patients with any systemic dexamethasone exposure within 7 days of surgery. Primary outcomes included wound infection, sepsis, and perioperative hematoma. Secondary outcomes included respiratory failure, delirium, new-onset diabetes, and in-hospital mortality. Propensity score matching (PSM) and logistic regression assessed associations.Results: After PSM, 42,472 patients were included in both the dexamethasone and control cohorts. At 30 days, dexamethasone exposure was associated with higher odds of wound infection. At 90 days, these associations included elevated risks for wound infection, respiratory failure, delirium, and sepsis. By 1 year, dexamethasone use remained significantly associated with wound infection, delirium, and respiratory failure, however, hospital-recorded mortality was lower in the dexamethasone cohort.Conclusion: In this large cohort, postoperative dexamethasone exposure was associated with increased risks of infectious and hospital-based complications, including wound infection. These findings support the need for prospective studies to define safe perioperative protocols in complex spine surgery.