Meta analysis on the relationship between preoperative epidural steroid injections and increased risk of postoperative surgical site infection

English Keywords:Epidural steroid injection  Lumbar surgery  Surgical site infection  Meta analysis

English Abstract:

  【Abstract】 Objectives: To investigate if there is relationship between preoperative epidural steroid injections and increased risk of postoperative surgical site infection(SSI). Methods: The search was made in PubMed, Embase, Cochran Trail from inception to July 2018. All control studies comparing the incidence of SSI within postoperative 90 days between the group with preoperative LESI and non-LESI were screened out for analysis. The observation(exposure) groups in each study received LESI and subsequent initial lumbar surgery in same segment while the control(non-exposure) group did not perform LESI while received lumbar surgery. The number of cases in each group was more than 100, and the follow-up time was at least 90 days. The evaluation index was the incidence of SSI within 90 days after lumbar surgery. The analysis was performed based on the time of LESI prior to surgery(＜1 month, 1-3 months, 3-6 months, 6-12 months). Newcastle-Ottawa Quality Scale(NOS) was applied to evaluate the quality of included studies. Subgroup analysis was used to explore heterogeneity and sensitivity analysis was used to determine the robustness of combined results, publication bias assessment was also performed by using Egger′s regression test. Results: Five studies which included 225801 patients(38452 patients in exposure group, 187349 patients in non-exposure group) were enrolled. All articles were from English literature, among them 1 was retrospective cohort study while the rest were retrospective case-control studies. The scores of NOS score system were 6 and above. LESI within 1 month before subsequent surgery significantly increased the risk of SSI in 90 days after surgery, OR=2.15(95%CI, 1.30-3.55), P＜0.05. LESI within 1-3 months before surgery significantly increased the risk of SSI in 90 days after surgery, OR=1.54 (95%CI, 1.36-1.74), P＜0.05. LESI within 3-6 months before surgery did not increase the risk of SSI, OR=1.09(95%CI, 0.94-1.26), P＞0.05. LESI within 6-12 months before surgery did not increase the risk of SSI, OR=1.30(95%CI, 0.88-1.93), P＞0.05. The subgroup analysis confirmed that unmatched baseline condition was a significant source of heterogeneity, and the sensitivity analysis confirmed our results were robust, publication bias were not found in included studies. Conclusions: Our results indicate that LESI within 1 month or 1-3 months before subsequent lumbar surgery significantly increase the risk of SSI.