133 - Use of Dexamethasone in the Immediate Post-operative Period is Associated with Increased Risk of Instrumentation and Surgical Site Complications in Diabetic Patients Undergoing Lumbar Spinal Fusion

Introduction/Study Question:
Dexamethasone is widely used in post-operative 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 post-operative complications.

Methods:
Patients undergoing 1- or 2-level posterior lumbar fusions with a diagnosis of diabetes mellitus who received dexamethasone within three days post-operatively 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 post-operatively. 7150 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 versus 3.48 days respectively (p= 0.0259).

Conclusion/

Discussion:
Administration of decadron in the post-operative 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 post-operative spinal fusion, is associated with increased risk of surgical site and instrumentation complications in diabetic patients, which should be considered before administration.