55. Surgical approach is associated with postoperative C5 palsy after decompression for degenerative cervical myelopathy: an analysis of the multicenter, prospective, randomized CSM-Protect clinical trial

BACKGROUND CONTEXT Dexamethasone is widely used in postoperative spine patients, and there are few studies investigating the effects in a diabetic population that is more at risk when receiving the medication. PURPOSE This study aims to determine the effects of dexamethasone on postoperative complications in diabetic patients undergoing 1- or 2-level lumbar fusions. STUDY DESIGN/SETTING This is a retrospective study of the PearlDiver database. PATIENT SAMPLE A total of 7,865 patients were analyzed for this study. Of these, 715 patients in the test group (female=372, male=343) received dexamethasone postoperatively. A total of 7,150 patients who did not receive dexamethasone were propensity-matched and included in the control group. OUTCOME MEASURES Medical complications including DVT, UTI, AKI, pneumonia, and transfusion were assessed at 90 days. Surgical site and instrumentation complications were assessed at 30 days, 90 days, and 1 year. METHODS Patients undergoing 1- or 2-level posterior lumbar fusions with a diagnosis of diabetes mellitus who received dexamethasone within three days postoperatively were identified using the PearlDiver database. Patients were propensity-matched in a 1:10 ratio to diabetic patients undergoing the same procedure who did not receive dexamethasone. Medical complications including DVT, UTI, AKI, pneumonia, and transfusion were assessed at 90 days. Surgical site and instrumentation complications were assessed at 30 days, 90 days, and 1 year. RESULTS A total of 7,865 patients comprise the basis of this analysis and were included in this study. 715 patients in the test group (female=372, male=343) received dexamethasone postoperatively. A total of 7,150 patients who did not receive dexamethasone were included in the control group. Patients in the test group had a significantly higher risk of DVT at 90 days (OR: 1.9 [1.2-3.0], p= 0.0068). There was no difference in UTI, AKI, pneumonia, or transfusion at 90 days (p>0.05). Surgical site complications 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 day (OR: 2.0 [1.16-3.43], p=0.012), 90 day (OR: 2.18 [1.45-3.28], p=0.0002), 1 year (OR: 1.63 [1.22-2.19], p=0.001). Length of stay was shorter in the test group, 3.29 days vs 3.48 days respectively (p= 0.0259). CONCLUSIONS Administration of dexamethasone in the postoperative period after lumbar fusion is associated with higher risk of surgical site and instrumentation complications at 30 days, 90 days, and 1 year in patients undergoing elective one- or two-level lumbar fusions. Dexamethasone, widely used in the management of postoperative spinal fusion, is associated with increased risk of surgical site and instrumentation complications in diabetic patients, which should be considered before administration. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Dexamethasone is widely used in postoperative spine patients, and there are few studies investigating the effects in a diabetic population that is more at risk when receiving the medication. This study aims to determine the effects of dexamethasone on postoperative complications in diabetic patients undergoing 1- or 2-level lumbar fusions. This is a retrospective study of the PearlDiver database. A total of 7,865 patients were analyzed for this study. Of these, 715 patients in the test group (female=372, male=343) received dexamethasone postoperatively. A total of 7,150 patients who did not receive dexamethasone were propensity-matched and included in the control group. Medical complications including DVT, UTI, AKI, pneumonia, and transfusion were assessed at 90 days. Surgical site and instrumentation complications were assessed at 30 days, 90 days, and 1 year. Patients undergoing 1- or 2-level posterior lumbar fusions with a diagnosis of diabetes mellitus who received dexamethasone within three days postoperatively were identified using the PearlDiver database. Patients were propensity-matched in a 1:10 ratio to diabetic patients undergoing the same procedure who did not receive dexamethasone. Medical complications including DVT, UTI, AKI, pneumonia, and transfusion were assessed at 90 days. Surgical site and instrumentation complications were assessed at 30 days, 90 days, and 1 year. A total of 7,865 patients comprise the basis of this analysis and were included in this study. 715 patients in the test group (female=372, male=343) received dexamethasone postoperatively. A total of 7,150 patients who did not receive dexamethasone were included in the control group. Patients in the test group had a significantly higher risk of DVT at 90 days (OR: 1.9 [1.2-3.0], p= 0.0068). There was no difference in UTI, AKI, pneumonia, or transfusion at 90 days (p>0.05). Surgical site complications 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 day (OR: 2.0 [1.16-3.43], p=0.012), 90 day (OR: 2.18 [1.45-3.28], p=0.0002), 1 year (OR: 1.63 [1.22-2.19], p=0.001). Length of stay was shorter in the test group, 3.29 days vs 3.48 days respectively (p= 0.0259). Administration of dexamethasone in the postoperative period after lumbar fusion is associated with higher risk of surgical site and instrumentation complications at 30 days, 90 days, and 1 year in patients undergoing elective one- or two-level lumbar fusions. Dexamethasone, widely used in the management of postoperative spinal fusion, is associated with increased risk of surgical site and instrumentation complications in diabetic patients, which should be considered before administration.