title: Preoperative steroid administration: effect on morbidity among patients undergoing intestinal bowel resection for Crohńs disease.
abstract: Long-term steroid therapy may predispose to increased perioperative morbidity in patients undergoing surgery with bowel anastomoses. The aim of our study was to review our data to determine if the steroid dosage is associated with the incidence of early complications after bowel resection in patients with prolonged steroid therapy for Crohńs disease (CD). Altogether, 397 patients underwent bowel resection with primary intestinal anastomoses for CD between 1982 and 2000 in our institution. The mortality and morbidity rates, anastomotic leakage, wound infections, intraabdominal abscesses, reoperation rate, and length of postoperative hospitalization in patients who were having high-dose (>/= 20 mg of prednisolone per day, n = 73) and low-dose (< 20 mg prednisolone per day, n = 146) steroid therapy for more than 1 month before surgery were compared with those of patients ( n = 177) who were not receiving steroids. Statistical analysis was performed using Fisher's exact test and Student's t-test, with p < 0.05 considered significant. The three groups were similar in terms of gender, duration since first diagnosis, American Society of Anesthesiologists classification, and obesity. Mortality, morbidity, anastomotic leakage, wound infections, intraabdominal abscesses, reoperation rate, and average postoperative stay were not statistically different in patients with high-dose, low-dose, or no steroid therapy. The only factor associated with increased morbidity was a low preoperative hemoglobin level. Our results demonstrate that, in patients who are undergoing bowel resection for CD, even high-dose prolonged preoperative systemic steroid therapy is not associated with increased postoperative complications.
authors.affiliation: Department of General Surgery, University of Muenster, Waldeyerstrasse 1, D-48149, Muenster, Germany. bruwer@uni-muenster.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruewer
authors.forename: Markus
authors.initials: M
authors.lastname: Utech
authors.forename: Emile J M
authors.initials: EJ
authors.lastname: Rijcken
authors.forename: Christoph
authors.initials: C
authors.lastname: Anthoni
authors.forename: Mike G
authors.initials: MG
authors.lastname: Laukoetter
authors.forename: Sabine
authors.initials: S
authors.lastname: Kersting
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Christian F
authors.initials: CF
authors.lastname: Krieglstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone