{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T21:48:36Z","timestamp":1747172916868,"version":"3.40.5"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:00Z","timestamp":1678233600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23000284_as1\"><jats:title>Objective:<\/jats:title><jats:p>To estimate the association between in situ steroids and spine surgical-site infections (SSIs), assessing spinal instrumentation as an effect modifier and adjusting for confounders.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as2\"><jats:title>Design:<\/jats:title><jats:p>Case\u2013control study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as3\"><jats:title>Setting:<\/jats:title><jats:p>Rural academic medical center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as4\"><jats:title>Participants:<\/jats:title><jats:p>We identified 1,058 adults undergoing posterior fusion and laminectomy procedures as defined by the National Healthcare Safety Network without a pre-existing SSI between January 2020 and December 2021. We identified 26 SSI as cases and randomly selected 104 controls from the remaining patients without SSI.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as5\"><jats:title>Methods:<\/jats:title><jats:p>The primary exposure was the intraoperative administration of methylprednisolone in situ (ie, either in the wound bed or as an epidural injection). The primary outcome was a clinical diagnosis of SSI within 6 months of a patient\u2019s first spine surgery at our facility. We quantified the association between the exposure and outcome using logistic regression, using a product term to assess for effect modification by spinal instrumentation and the change-in-estimate approach to select significant confounders.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as6\"><jats:title>Results:<\/jats:title><jats:p>Adjusting for Charlson comorbidity index and malignancy, in situ steroids were significantly associated with spine SSI relative to no in situ steroids for instrumented procedures (adjusted odds ratio [aOR], 9.93; 95% confidence interval [CI], 1.54\u201364.0), but they were not associated with spine SSIs among noninstrumented procedures (aOR, 0.86; 95% CI, 0.15\u20134.93).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000284_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>In situ steroids were significantly associated with spine SSI among instrumented procedures. The benefits of in situ steroids for pain management following spine surgery should be weighed against the risk of SSI, especially for instrumented procedures.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.28","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T08:07:54Z","timestamp":1678262874000},"page":"1596-1600","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Association between in situ steroids and spine surgical site infections among instrumented procedures"],"prefix":"10.1017","volume":"44","author":[{"given":"James E.","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen O.","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Swain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evalina","family":"Bond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Calderwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-6797","authenticated-orcid":false,"given":"Justin J.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,3,8]]},"reference":[{"key":"S0899823X23000284_ref5","first-page":"546","article-title":"Effects of corticosteroid on the healing bowel anastomosis","volume":"50","author":"Aszodi","year":"1984","journal-title":"Am Surg"},{"key":"S0899823X23000284_ref3","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.135.11.1265"},{"key":"S0899823X23000284_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2017.09.025"},{"key":"S0899823X23000284_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.244"},{"key":"S0899823X23000284_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.10.133"},{"key":"S0899823X23000284_ref9","doi-asserted-by":"publisher","DOI":"10.1086\/605323"},{"key":"S0899823X23000284_ref12","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2020.107"},{"key":"S0899823X23000284_ref14","unstructured":"14. 2022 Operative procedure code documents. Center for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/psc\/ssi\/index.html. Published online June 2022. Accessed October 3, 2022."},{"key":"S0899823X23000284_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivz309"},{"key":"S0899823X23000284_ref8","doi-asserted-by":"publisher","DOI":"10.1086\/502112"},{"key":"S0899823X23000284_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2019.06.011"},{"key":"S0899823X23000284_ref17","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0b013e3182a1ddd3"},{"key":"S0899823X23000284_ref1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.4103\/sni.sni_478_16","article-title":"Perioperative steroids for lumbar disc surgery: a meta-analysis of randomized controlled trials","volume":"8","author":"Waqas","year":"2017","journal-title":"Surg Neurol Int"},{"key":"S0899823X23000284_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.193"},{"key":"S0899823X23000284_ref18","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.20.00259"},{"key":"S0899823X23000284_ref19","doi-asserted-by":"publisher","DOI":"10.3171\/2018.7.SPINE18584"},{"key":"S0899823X23000284_ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.09.057"},{"key":"S0899823X23000284_ref16","doi-asserted-by":"publisher","DOI":"10.3171\/2015.7.FOCUS15269"},{"key":"S0899823X23000284_ref6","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2021.0164"},{"key":"S0899823X23000284_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.307"},{"key":"S0899823X23000284_ref21","first-page":"CD011940","article-title":"Adverse side effects of dexamethasone in surgical patients","volume":"11","author":"Polderman","year":"2018","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X23000284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,24]],"date-time":"2024-05-24T03:16:32Z","timestamp":1716520592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X23000284\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,8]]},"references-count":21,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["S0899823X23000284"],"URL":"https:\/\/doi.org\/10.1017\/ice.2023.28","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"type":"print","value":"0899-823X"},{"type":"electronic","value":"1559-6834"}],"subject":[],"published":{"date-parts":[[2023,3,8]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}