BACKGROUND: Corticosteroid use continues to rise nationally. Studies have evaluated the impact of chronic steroid use on surgical outcomes in smaller populations. This study investigated the impact of chronic steroid use on perioperative surgical outcomes in a surgical cohort of more than 5 million surgical patients, using a statistically rigorous methodology. METHODS: The National Surgical Quality Improvement Program Database was queried 2008-2016 to evaluate chronic steroid use. Patient demographics, comorbidities, and outcomes were compared, using χ2 and t test analysis, and then repeated after propensity score matching. Finally, a double-adjustment logistic regression was utilized, yielding odds ratios to assess the effect of chronic steroids on perioperative outcomes within the matched population. RESULTS: Between 2008 and 2016, a total of 5,244,588 patients met inclusion criteria, of whom 181,901 (3.5%) were taking steroids for a minimum of 30 days before surgery. Patients on chronic steroids had significantly more comorbidities compared with the remaining population. After propensity score matching and double-adjusted logistic regression, chronic steroid use was found to be associated with increased surgical complications and poorer surgical outcomes. Chronic steroid use significantly increased a patient's risk of having a hospital stay longer than 30 days by 19%, risk of readmission within 30 days by 58%, risk of reoperation by 21%, and risk of death by 32%. CONCLUSION: After controlling for differences in comorbidities and demographics, patients on chronic steroids have significantly poorer perioperative outcomes. Chronic steroid use should be evaluated and, if possible, addressed before surgery, given their significant impact on surgical outcomes.
BACKGROUND: Corticosteroid use continues to rise nationally. Studies have evaluated the impact of chronic steroid use on surgical outcomes in smaller populations. This study investigated the impact of chronic steroid use on perioperative surgical outcomes in a surgical cohort of more than 5 million surgical patients, using a statistically rigorous methodology. METHODS: The National Surgical Quality Improvement Program Database was queried 2008-2016 to evaluate chronic steroid use. Patient demographics, comorbidities, and outcomes were compared, using χ2 and t test analysis, and then repeated after propensity score matching. Finally, a double-adjustment logistic regression was utilized, yielding odds ratios to assess the effect of chronic steroids on perioperative outcomes within the matched population. RESULTS: Between 2008 and 2016, a total of 5,244,588 patients met inclusion criteria, of whom 181,901 (3.5%) were taking steroids for a minimum of 30 days before surgery. Patients on chronic steroids had significantly more comorbidities compared with the remaining population. After propensity score matching and double-adjusted logistic regression, chronic steroid use was found to be associated with increased surgical complications and poorer surgical outcomes. Chronic steroid use significantly increased a patient's risk of having a hospital stay longer than 30 days by 19%, risk of readmission within 30 days by 58%, risk of reoperation by 21%, and risk of death by 32%. CONCLUSION: After controlling for differences in comorbidities and demographics, patients on chronic steroids have significantly poorer perioperative outcomes. Chronic steroid use should be evaluated and, if possible, addressed before surgery, given their significant impact on surgical outcomes.
Authors: Federico Coccolini; Mario Improta; Massimo Sartelli; Kemal Rasa; Robert Sawyer; Raul Coimbra; Massimo Chiarugi; Andrey Litvin; Timothy Hardcastle; Francesco Forfori; Jean-Louis Vincent; Andreas Hecker; Richard Ten Broek; Luigi Bonavina; Mircea Chirica; Ugo Boggi; Emmanuil Pikoulis; Salomone Di Saverio; Philippe Montravers; Goran Augustin; Dario Tartaglia; Enrico Cicuttin; Camilla Cremonini; Bruno Viaggi; Belinda De Simone; Manu Malbrain; Vishal G Shelat; Paola Fugazzola; Luca Ansaloni; Arda Isik; Ines Rubio; Itani Kamal; Francesco Corradi; Antonio Tarasconi; Stefano Gitto; Mauro Podda; Anastasia Pikoulis; Ari Leppaniemi; Marco Ceresoli; Oreste Romeo; Ernest E Moore; Zaza Demetrashvili; Walter L Biffl; Imitiaz Wani; Matti Tolonen; Therese Duane; Sameer Dhingra; Nicola DeAngelis; Edward Tan; Fikri Abu-Zidan; Carlos Ordonez; Yunfeng Cui; Francesco Labricciosa; Gennaro Perrone; Francesco Di Marzo; Andrew Peitzman; Boris Sakakushev; Michael Sugrue; Marja Boermeester; Ramiro Manzano Nunez; Carlos Augusto Gomes; Miklosh Bala; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2021-08-09 Impact factor: 5.469