Adverse effects of preoperative steroid use on surgical outcomes

Background

Preoperative steroid use has been associated with increased postoperative complications. We sought to establish these risks using data from the National Surgical Quality Improvement Program (NSQIP).

Methods

NSQIP public use files from 2005 to 2008 were analyzed for preoperative steroid use and postoperative adverse events.

Results

Of 635,265 patients identified, 20,434 (3.2%) used steroids preoperatively. Superficial surgical site infections (SSI) increased from 2.9% to 5% using steroids (odds ratio, 1.724). Deep SSIs increased from .8% to 1.8% (odds ratio, 2.353). Organ/space SSIs and dehiscence increased 2 to 3-fold with steroid use (odds ratios, 2.469 and 3.338, respectively). Mortality increased almost 4-fold (1.6% to 6.0%; odds ratio, 3.920). All results were significant (P < .001).

Conclusions

Previous concerns related to surgical risks in patients on chronic steroid regimens appear valid. These results may assist in counceling patients regarding the increased risk of surgery. They may also help the surgeon plan and modify the procedure if possible.