Perioperative Steroid Management in IBD Patients Undergoing Colorectal Surgery

Abstract

Colorectal surgeons must be familiar and confident with perioperative steroid management in patients with inflammatory bowel disease (IBD) as their underlying disease and associated comorbidities introduce several challenges. While suppression of the hypothalamic-pituitary adrenal axis is known to occur with chronic steroid supplementation, the dosage or duration of steroid exposure required to suppress an appropriate endogenous response to surgical stress is unknown. Historically, standard practice included stress-dose or high-dose perioperative steroid administration in any steroid-dependent patient undergoing surgery to prevent adrenal insufficiency; however, perioperative high-dose steroids are not without consequence. Over the past 6 decades, several large case series have been conducted in both IBD and non-IBD patients challenging the practice of stress-dose steroid administration, but there remains great variability in perioperative steroid dosing practices for IBD patients undergoing surgery. In this chapter, we review the literature and evidence surrounding perioperative steroid dosing followed by our recommendations for steroid management in patients with IBD undergoing colorectal surgery. Based on the available data, we recommend that steroid-treated IBD patients undergoing major colorectal surgery be managed with low-dose perioperative steroids equivalent to their preoperative steroid dose in the perioperative period.