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Maintenance Inhaled Corticosteroid Use is Associated With Increased Revision Risk in Asthmatic Patients Undergoing

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Asthma patients using inhaled corticosteroids (ICS) have a higher risk of revision surgery after lumbar fusion compared to those not using ICS or asthma-free individuals. This suggests ICS may negatively impact spinal fusion outcomes.

Keywords:
asthmainhaled corticosteroidslumbar fusionlumbar fusion revision surgeryoral steroidsosteoporosis

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Area of Science:

  • Orthopedic Surgery
  • Pulmonology
  • Pharmacology

Background:

  • Lumbar fusion is a common surgical procedure for spinal conditions.
  • Asthma is a chronic respiratory disease affecting millions globally.
  • Inhaled corticosteroids (ICS) are a mainstay treatment for asthma management.

Purpose of the Study:

  • To investigate the association between maintenance inhaled corticosteroid (ICS) therapy and all-cause revision rates following lumbar fusion.
  • To compare revision rates in three distinct patient groups: asthmatic patients on ICS, asthmatic patients not on ICS, and asthma-free controls.

Main Methods:

  • Retrospective cohort study utilizing a real-world health records database.
  • Inclusion of three cohorts: asthmatic patients on maintenance ICS, asthmatic patients without ICS, and asthma-free controls.
  • Propensity-score matching to control for confounding variables, followed by Chi-square tests and Kaplan-Meier analyses for revision rate comparison at 2 and 5 years post-fusion.

Main Results:

  • Asthmatic patients on maintenance ICS showed significantly higher rates of revision surgery at both 2 and 5 years post-lumbar fusion compared to asthmatic patients not on ICS (OR=3.11-3.16, P<0.001).
  • A similar increased risk of revision was observed in asthmatic patients on maintenance ICS when compared to asthma-free controls (OR=3.48-3.98, P<0.001).
  • No significant difference in revision hazard was found between asthmatic patients without ICS and asthma-free controls over 5 years (P=0.082).

Conclusions:

  • Maintenance ICS therapy is associated with an elevated risk of revision after lumbar fusion in patients with asthma.
  • These findings indicate that ICS, often considered safe, may have significant implications for spinal fusion success.
  • Further research is recommended to explore the underlying biological mechanisms linking ICS use to lumbar fusion revision.