Preoperative Inhaled Corticosteroid Use Is Associated With Incidental Durotomy After Primary Lumbar Laminectomy

Study Design:

Retrospective multicenter cohort study.

Objective:

To evaluate whether preoperative inhaled corticosteroid (ICS) use is associated with incidental durotomy (ID) and other postoperative complications after primary lumbar laminectomy.

Summary of Background Data:

Systemic corticosteroid use is associated with increased ID risk in spine surgery, but inhaled formulations have largely been excluded from prior studies. Whether ICS use is associated with ID after lumbar decompression is unknown.

Methods:

The TriNetX Global Collaborative Network was queried to identify adults who underwent primary lumbar laminectomy using CPT codes 63005, 63017, and 63047.

The primary exposure was an active ICS prescription from 1 year to 1 day preoperatively. Patients with oral or parenteral glucocorticoid exposure during the prior year were excluded. Propensity matching for relevant comorbidity and operative covariates was performed. The primary outcome was ID at 30 and 90 days. Secondary outcomes were all-cause return to the operating room (RTOR), surgical site infection, RTOR for infection, sepsis, venous thromboembolism, pulmonary embolism, and allogeneic transfusion. A sensitivity analysis excluded patients with emphysema or chronic obstructive pulmonary disease.

Results:

A total of 4541 ICS users and 86,744 controls were included. After matching, 4537 patients remained in each cohort. ICS use was associated with higher ID rates at 30 days (5.8% vs . 4.8%; RR 1.21, P =0.031) and 90 days (6.1% vs . 5.0%; RR 1.23, P =0.019). All-cause RTOR was higher at 30 days (6.5% vs . 5.2%; RR 1.25, P =0.009) and 90 days (7.2% vs . 6.1%; RR 1.18, P =0.034). RTOR for infection was higher at 30 days (1.9% vs . 1.1%; RR 1.69, P =0.002). Other secondary outcomes did not differ significantly. These findings persisted in the sensitivity analysis.

Conclusion:

Preoperative ICS use was associated with higher rates of ID and all-cause reoperation after primary lumbar laminectomy and may represent an underrecognized patient-level risk marker.