title: Propensity score analysis evaluating preoperative glucocorticoid administration in elective colectomy.
abstract: BACKGROUND
  Preoperative glucocorticoid (GC) administration attenuates the physiological response to surgery and improves clinical outcomes. However, GC use is not yet universally implemented. A propensity score analysis was performed to evaluate preoperative GC use in elective colectomy.
  
  
  METHODS
  A retrospective review of prospectively collected data was conducted for all patients who had undergone elective colectomy within an established Enhanced Recovery After Surgery (ERAS) programme at our institution from January 2006 to 2010. Demographic data, surgery type, glucocorticoid administration and clinical outcomes including complication rates and length of hospital stay (LOS) were investigated. Univariate and propensity score analyses were conducted with statistical significance identified as p ≤ 0.05.
  
  
  RESULTS
  There were 253 patients included in the analysis, of which 146 received preoperative GC. There were significant baseline differences between those who received GC and those who did not in male gender (GC: 56 (38%); non-GC: 58 (54%); p = 0.02) and American Society of Anesthesiologists (ASA) III (GC: 40 (27%); non-GC: 43 (40%); p = 0.04). On univariate analysis, there were no significant differences in the incidence of total complications, major complication, anastomotic leak and infectious complication. On propensity score analysis, preoperative GC administration was found to be independently associated with a reduction in LOS (GC: 5; Non-GC: 6; p = 0.04).
  
  
  CONCLUSIONS
  Preoperative GC administration is associated with a reduction in LOS without an increase in postoperative complications.
authors.affiliation: Department of Surgery, South Auckland Clinical School, University of Auckland, New Zealand. Daniel.Lemanu@middlemore.co.nz
authors.forename: Daniel
authors.initials: D
authors.lastname: Lemanu
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.forename: Primal
authors.initials: P
authors.lastname: Singh
authors.forename: Arman
authors.initials: A
authors.lastname: Kahokehr
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000517:prevention & control; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D057216:Propensity Score; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids