title: Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery.
abstract: BACKGROUND
  Corticosteroids are the mainstay of medical therapies to induce remission in acute episodes of inflammatory bowel disease (IBD). However, evidence suggests that this may increase the risk of postoperative complications among patients with IBD who go on to have abdominal surgery.
  
  
  OBJECTIVE
  To estimate the risk of postoperative complications following abdominal surgery in patients with IBD on steroids at the time of abdominal surgery.
  
  
  METHODS
  Meta-analysis of observational studies.
  
  
  METHODS
  We searched medical electronic databases for full journal articles published after 1965 reporting on postoperative complications in patients with IBD undergoing abdominal surgery provided they compared patients treated with steroids with those not on steroids. We hand searched the reference lists of all retrieved articles. Two independent reviewers extracted data from studies meeting the inclusion criteria and any discrepancies were resolved by discussion. We carried out fixed effects meta-analysis, funnel plot and sensitivity analyses.
  
  
  RESULTS
  A total of seven observational studies involving 1,532 patients met the inclusion criteria for risk of total complications, and five observational studies involving 1,714 patients met the inclusion criteria for risk of infectious complications. Pooled analysis showed an increased risk of all postoperative complications (OR 1.41, 95% confidence interval 1.07-1.87), as well as an increased risk of postoperative infectious complications (OR 1.68, 95% confidence interval 1.24-2.28) among patients on steroids. Patients who received higher doses of perioperative oral steroids (>40 mg) had a higher risk of total complications (OR 2.04 (95% CI 1.28-3.26).
  
  
  CONCLUSIONS
  There is an increased risk of total as well as infectious complications following the use of steroids in patients with IBD.
authors.affiliation: Department of Gastroenterology, St. George's Hospital NHS Trust, London, United Kingdom.
authors.forename: Venkataraman
authors.initials: V
authors.lastname: Subramanian
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Kang
authors.forename: Richard C G
authors.initials: RC
authors.lastname: Pollok
mesh_terms: D000005:Abdomen / Q000601:surgery*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D011183:Postoperative Complications; D012306:Risk; D013256:Steroids / Q000009:adverse effects*
chemical_list: D013256:Steroids