Effect of Preoperative Acupuncture and Epidural Steroid Injection on Early Postoperative Infection After Lumbar Spinal Fusion

Abstract

Background: Acupuncture and epidural steroid injection (ESI) are frequently performed in patients with degenerative lumbar disease. The purpose of this study was to explore preoperative acupuncture and ESI as risk factors for postoperative infection after elective lumbar fusion.

Methods: Patients >50 years of age who underwent spinal fusion due to degenerative lumbar disease from 2010 to 2019 were identified by diagnostic and procedural codes using a nationwide database. The incidence of spinal infection within 90 days after surgery was identified. Patients who underwent acupuncture and/or ESI within 90 days prior to spinal surgery were identified using procedural codes. The infection rate was analyzed by dividing patients into 4 groups as follows: patients who underwent neither acupuncture nor ESI (unexposed group), patients who underwent acupuncture only (acupuncture group), patients who underwent ESI only (ESI group), and patients who underwent both acupuncture and ESI (combined group). Cox regression analysis was performed to identify risk factors for postoperative spinal infection.

Results: A total of 207,806 patients were included in this study. The postoperative infection rate among all patients was 4.29%. The infection rates in the unexposed, acupuncture, ESI, and combined groups were 4.17% (4,342 of 104,106 patients), 3.90% (340 of 8,726 patients), 4.48% (3,761 of 83,882 patients), and 4.26% (473 of 11,092 patients), respectively. Increasing age, male sex, and ESI were demonstrated to be risk factors for postoperative spinal infection. ESI was no longer a risk factor when patients who received acupuncture or ESI within 2 weeks of spinal surgery were excluded. Preoperative acupuncture was not associated with postoperative spinal infection.

Conclusions: Acupuncture and ESI performed >2 weeks prior to spinal surgery did not increase the risk of postoperative infection.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.