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Updated: Jun 16, 2026
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Chronic Corticosteroid Use Is Associated with Increased Postoperative Complications Following Lumbar Microdiscectomy
Levi M Travis1, Solomon G Jackson1, Aneesh V Samineni1
1Department of Orthopaedics, University of Miami Miller School of Medicine, Miami, FL, USA.
Introduction:
Lumbar microdiscectomy (MLD) is a safe and effective treatment for lumbar disc herniation with low complication rates. However, short-term perioperative complications remain a concern for at-risk patients. Chronic corticosteroid use has been linked to impaired healing and infection in other spinal procedures, yet its impact in MLD remains poorly defined. This study aimed to evaluate the association between chronic corticosteroid use and 30-day complications following elective lumbar MLD.
Methods:
A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2016 to 2023. Data were collected from adult patients (≥18 years) undergoing microdiscectomy. Patients with fusion procedures or systemic illnesses were excluded. Corticosteroid use was defined according to the NSQIP variable as systemic use within 30 days prior to surgery. A 3:1 nearest-neighbor propensity score matching was performed on key covariates. Multivariable logistic regression was adjusted for race, ethnicity, operative year, and inpatient status.
Results:
Of 64,380 eligible patients, 2,439 (3.8%) used chronic steroids. Post-matching yielded a cohort of 9,648 patients with well-balanced characteristics. Chronic steroid users had significantly higher odds of 30-day readmission (odds ratio [OR]=1.41; 95% confidence interval [CI]: 1.12-1.77; p=0.003), pneumonia (OR=2.21; 95% CI: 1.08-4.44; p=0.026), deep vein thrombosis (OR=2.04; 95% CI: 1.00-4.08; p=0.046), and sepsis (OR=3.18; 95% CI: 1.60-6.37; p<0.001). Operative time, transfusion rates, and length of stay were similar. Most patients were discharged home, with no differences in disposition between groups.
Conclusions:
Chronic corticosteroid use is independently associated with increased risks of postoperative sepsis, deep vein thrombosis, pneumonia, and readmission following lumbar microdiscectomy. These findings highlight the importance of perioperative risk stratification and surveillance in this subgroup. Surgeons should consider proactive risk mitigation strategies, such as perioperative infection prophylaxis, pulmonary hygiene, and enhanced thromboprophylaxis, when managing these patients. Further prospective studies are warranted to enhance outcomes in this population.
Insights
Chronic corticosteroid use significantly increases risks of sepsis, pneumonia, deep vein thrombosis, and readmission after lumbar microdiscectomy (MLD). Patients on steroids require enhanced perioperative surveillance and risk mitigation strategies for better outcomes.
Area of Science:
- Neurosurgery
- Surgical Outcomes
- Pharmacology
Background:
- Lumbar microdiscectomy (MLD) is a common procedure for lumbar disc herniation.
- Short-term complications are a concern, especially in at-risk patients.
- The impact of chronic corticosteroid use on MLD complications is not well-defined.
Purpose of the Study:
- To evaluate the association between chronic corticosteroid use and 30-day complications following elective lumbar MLD.
- To identify specific risks associated with steroid use in MLD patients.
Main Methods:
- Retrospective cohort study using the NSQIP database (2016-2023).
- Included adult patients undergoing MLD, excluding fusion or systemic illnesses.
- Propensity score matching and multivariable logistic regression were used to analyze outcomes.
Main Results:
- Chronic steroid users (3.8%) had higher odds of 30-day readmission (OR=1.41), pneumonia (OR=2.21), deep vein thrombosis (OR=2.04), and sepsis (OR=3.18).
- Operative time, transfusion rates, and length of stay were similar between groups.
- No significant differences in patient disposition were observed.
Conclusions:
- Chronic corticosteroid use is an independent risk factor for increased postoperative sepsis, DVT, pneumonia, and readmission after MLD.
- Perioperative risk stratification and proactive mitigation strategies are crucial for steroid-using patients.
- Further prospective studies are needed to optimize outcomes in this population.
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