The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease

Abstract

BackgroundInflammatory bowel disease (IBD) patients are frequently treated with steroids prior to surgery. We characterized the association between preoperative steroid use and postoperative complications in a large prospective cohort. MethodsWe identified patients who underwent major IBD-related abdominal surgery in the American College of Surgeon's National Surgical Quality Improvement Program (ACS-NSQIP) between 2005 and 2012. We compared the risk of postoperative complications and 30-day mortality between preoperative steroid users and non-users. ResultsWe identified 8260 Crohn's disease (CD) and 7235 ulcerative colitis (UC) patients who underwent major abdominal surgery. Preoperative steroid use was associated with higher risk of postoperative complications, excluding death, in both CD (22.6% vs. 18.5%, P<0.0001) and UC (30.1% vs. 22.5%, P<0.0001). The adjusted odds ratio for any postoperative complication associated with steroids was 1.26 (95% CI: 1.12–1.41) for CD and 1.44 (95% CI: 1.28–1.61) for UC. Infectious complications were more frequent with steroid use in both CD (15.2% vs. 12.9%, P=0.004) and UC (19.4% vs. 15.6%, P<0.0001), specifically intra-abdominal infections and sepsis. Steroid use was associated with increased risk of venous thromboembolism (VTE) in both CD (OR, 1.66; 95% CI: 1.17–2.35) and UC (OR, 2.66; 95% CI: 2.01–3.53). 30-day mortality did not differ among steroid users and non-users (6.8/1000 vs. 5.8/1000, P=0.58 for CD; 13.5/1000 vs. 15.2/1000, P=0.55 for UC). ConclusionsPreoperative steroids are associated with higher risk of postoperative sepsis and VTE in IBD. Increased infectious control measures and VTE prophylaxis may reduce adverse events.