Barbara Buccilli

Objective: Dexamethasone is commonly prescribed following adult spinal deformity (ASD) surgery; however, dexamethasone’s immunosuppressive effects on clinical outcomes in ASD surgery remain unclear. This study sought to: assess the effects of postoperative dexamethasone after ASD surgery, and evaluate the potential association between postoperative dexamethasone and complications.Methods: This TriNetX study identified adults who underwent ASD surgery from 2009–2024. Outcomes were explored at 30-day, 90-day, and 1-year time points among patients with any systemic dexamethasone exposure within 7 days of surgery. Primary outcomes included wound infection, sepsis, and perioperative hematoma. Secondary outcomes included respiratory failure, delirium, new-onset diabetes, and in-hospital mortality. Propensity score matching (PSM) and logistic regression assessed associations.Results: After PSM, 42,472 patients were included in both the dexamethasone and control cohorts. At 30 days, dexamethasone exposure was associated with higher odds of wound infection. At 90 days, these associations included elevated risks for wound infection, respiratory failure, delirium, and sepsis. By 1 year, dexamethasone use remained significantly associated with wound infection, delirium, and respiratory failure, however, hospital-recorded mortality was lower in the dexamethasone cohort.Conclusion: In this large cohort, postoperative dexamethasone exposure was associated with increased risks of infectious and hospital-based complications, including wound infection. These findings support the need for prospective studies to define safe perioperative protocols in complex spine surgery.

BACKGROUND AND OBJECTIVE: Intrathecal drug delivery (IDD) is an established therapy for cancer-related pain, spasticity, and refractory noncancer-related chronic pain. Despite its clinical benefits, IDD implantation remains associated with a substantial complication burden, frequently necessitating revision surgery. Although complication rates are well described, operative strategies to mitigate these risks are inconsistently reported. We aimed to systematically map operative and perioperative strategies for IDD system implantation with a focus on complication mitigation, and to integrate practical technical insights into a standardized workflow with these data and our technical pearls garnered over 15 years. METHODS: A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception through February 2026 for studies describing IDD implantation techniques, perioperative management, and associated complications. Eligible studies included randomized trials, observational studies, case series, and technical reports. Findings were synthesized qualitatively and organized according to the procedural workflow, including preoperative, intraoperative, and postoperative phases. RESULTS: A total of 45 studies met inclusion criteria. The most frequently reported complications included catheter-related malfunction, cerebrospinal fluid leaks, infection, and pump-related issues such as migration or rotation. Operative techniques to mitigate these risks are provided for catheter insertion approach, anchoring, and pump pocket construction. Infection prevention measures and standardized perioperative protocols also demonstrated an important role in reducing adverse events. We provide a workflow based on these data and our own experience. CONCLUSION: Complication risk in IDD implantation is strongly influenced by operative technique and perioperative management. Existing literature lacks standardization in both technical reporting and outcome definitions, highlighting the need for consensus frameworks. We provide a systems-based approach integrating procedural standardization, technical precision, and coordinated perioperative care may improve reproducibility and reduce complication rates.

Background: The relationship between obesity and traumatic brain injury is complex and not fully understood. While obesity is commonly linked to worse outcomes, conflicting data support the “obesity paradox,” with higher body mass index showing protective effects. Methods: We identified patients with traumatic brain injury and defined two propensity score–matched cohorts: patients with normal weight and patients with obesity. Outcomes were compared using risk estimates, odds ratios, Kaplan–Meier survival analysis, and log‐rank testing. Results: Obesity was associated with slightly lower risks of the following: • Pneumonia (5.1% vs. 3.4%, OR 1.53 [95% CI: 1.015–2.297], p = 0.041), • Acute kidney injury (9.3% vs. 6.8%, OR 1.41 [95% CI: 1.047–1.908], p = 0.023), • Myocardial infarction (3.4% vs. 1.7%, OR 2.04 [95% CI: 1.182–3.503], p = 0.009), • Cognitive deficits (16.9% vs. 11.9%, OR 1.52 [95% CI: 1.201–1.914], p < 0.001), • Cardiac arrest (2.5% vs. 0.8%, OR 3.05 [95% CI: 1.485–6.272], p = 0.001), • Emergency department visits or admissions (16.1% vs. 12.7%, OR 1.32 [95% CI: 1.046–1.661], p = 0.019), • Emergency procedures (16.1% vs. 11.9%, OR 1.43 [95% CI: 1.127–1.803], p = 0.003), • Twist drill/burr hole procedures (1.7% vs. 0.8%, HR 2.67 [95% CI: 1.045–6.827], p = 0.033 by log‐rank test), • Mortality was not significantly different. Conclusions: Patients with obesity exhibited a lower incidence of selected complications, supporting the obesity paradox in neurotrauma. However, that did not translate into differences in mortality or functional outcomes. Body mass index may not fully capture the complexities of body composition or functional reserve, highlighting the need for studies using comprehensive adiposity and metabolic measures. Given multiple outcomes tested and modest effect sizes, these findings should be interpreted cautiously.