Impact of Immunosuppression Type on 30-Day Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion: A Retrospective National Cohort Study of 66,162 Patients

Study DesignRetrospective Cohort Study.ObjectivesPerioperative immunosuppression management in spine surgery lacks robust evidence. Most NSQIP-based ACDF models utilize a binary steroid variable, failing to distinguish corticosteroids from biologics or synthetic DMARDs. This study uses the granular NSQIP immunosuppression category and propensity score matching (PSM) to validate these risks.MethodsPrimary ACDF patients were identified in ACS NSQIP (2015-2021; N=66,162). The primary exposure was preoperative corticosteroid use; a secondary analysis utilized the 2021 granular immunosuppression variable (n=9,761). The primary outcome was a 30-day composite adverse event (complication, readmission, reoperation, or mortality). Analysis included multivariable logistic regression and 1:3 PSM.ResultsPreoperative corticosteroid exposure (3.8%) independently predicted the composite outcome (aOR 1.35, 95% CI 1.16-1.56), readmission (aOR 1.37), and medical complications (aOR 1.38; all p