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.

中文翻译：

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术前针灸硬膜外类固醇注射对腰椎融合术后早期感染的影响。


背景 针灸和硬膜外类固醇注射 （ESI） 经常对退行性腰椎病患者进行。本研究的目的是探讨术前针灸和 ESI 作为择期腰椎融合术后感染的危险因素。方法 使用 2010 年至 2019 年因退行性腰椎疾病接受脊柱融合术的患者 >50 岁，使用全国数据库通过诊断和程序代码进行识别。确定了手术后 90 天内脊柱感染的发生率。使用程序代码确定脊柱手术前 90 天内接受过针灸和/或 ESI 的患者。将患者分为 4 组，分析感染率：既未接受针灸也不接受 ESI 的患者 （未暴露组）、仅接受针灸的患者 （针灸组）、仅接受 ESI 的患者 （ESI 组） 和同时接受针灸和 ESI 的患者 （联合组）。进行 Cox 回归分析以确定术后脊柱感染的危险因素。结果 本研究共纳入 207,806 例患者。所有患者的术后感染率为 4.29%。未暴露组、针灸组、ESI 组和联合组的感染率分别为 4.17%（104,106 名患者中 4,342 名）、3.90%（8,726 名患者中的 340 名）、4.48%（83,882 名患者中的 3,761 名）和 4.26%（11,092 名患者中的 473 名）。年龄增长、男性和 ESI 被证明是术后脊柱感染的危险因素。当排除脊柱手术后 2 周内接受针灸或 ESI 的患者时，ESI 不再是危险因素。术前针灸与术后脊柱感染无关。 结论 脊柱手术前 >2 周进行针灸和 ESI 不会增加术后感染的风险。证据级别 预后 III 级。有关证据级别的完整描述，请参阅作者说明。