Association between chronic steroids and outcomes in hepatobiliary and pancreatic surgery

Abstract

BackgroundChronic steroid use has been associated with increased postoperative complication; however, the association between chronic steroids and hepatobiliary and pancreatic surgery through all aspects of disease etiologies and types of surgery performed remains an area of active research. Therefore, this study analyzed the association of chronic steroids use with outcomes after hepatobiliary and pancreatic surgery. MethodsThe National Surgical Quality Improvement Program Participant Use Data Files for hepatobiliary and pancreatic surgeries performed between 2015 and 2019 were analyzed for chronic steroid use and postoperative adverse events. ResultsA total of 54,382 patients underwent hepatobiliary or pancreatic surgery during the study period, of which 1672 (3.1%) were on chronic steroids. In patients undergoing pancreatic surgery, steroid use was associated with higher rates of pneumonia (odds ratio [OR] 1.3, 95% confidence interval [95% CI] 1.2–2.2), unplanned intubation (OR 1.2, 95% CI 1.1–2.3), readmission (OR 1.4, 95% CI 1.3–2.4), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.2–2.3), being more likely to remain on a ventilator for greater than 48 h (OR 1.4, 95% CI 1.2–1.9), and greater mortality (OR 1.2, 95% CI 1.1–3.1) when compared to those, not on chronic steroids. In patients undergoing hepatobiliary surgery, chronic steroid use was associated with higher rates of sepsis (OR 1.3, 95% CI 1.2–2.9), unplanned intubation (OR 1.4, 95% CI 1.2–2.7), intraoperative or postoperative transfusions (OR 1.5, 95% CI 1.3–2.3), and readmission (OR 1.2, 95% CI 1.0–1.9). There was no difference in pancreatic fistula rates or post-hepatectomy liver failure rates after pancreatic and hepatobiliary resections, respectively. ConclusionChronic steroids use was associated with higher rates of poor outcomes both perioperatively and postoperatively in pancreatic and hepatobiliary surgery. These results will allow clinicians to be better equipped to counsel patients on surgery's increased risks and establish various perioperative protocols for chronic steroid users.