Chronic Corticosteroid Use Is Associated with Increased Postoperative Complications Following Lumbar Microdiscectomy

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