title: Impact of high preoperative steroid doses on postoperative complications among patients on prolonged preoperative steroid therapy.
abstract: Corticosteroids are essential to maintain the organic homeostasis. Steroid, glucocorticoid or its synthetic analog is widely used for inflammatory and autoimmune diseases. Prolonged steroid therapy is reported to cause the susceptibility to infection, impaired wound healing and psychoneurosis, however whether the quantity of taking the preoperative steroid is associated the postoperative complication is still unknown. The aim of this study was to elucidate whether the steroid dose in patients on prolonged preoperative steroid therapy is associated postoperative morbidity and mortality. Twenty-five patients taking steroid for various illnesses and underwent the surgery under general anesthesia were selected in this study. The mean +/- standard deviation and the median of the steroid dose converted into hydrocortisone (mg/day) were 39.2 +/- 31.0 and 20, respectively. Of 25 cases, postoperative complications were seen in 10 cases. The postoperative complication was severe based on the grade of Clavien and Dindo by ANOVA as the doses of taking steroid increased (p = 0.0171). The grave postoperative complication classified as Clavien and Dindo grade III occurred with 100% sensitivity and 87% specificity for the steroid dose converted into hydrocortisone > 80 mg/day. Preoperative taking the large amount of steroid (> 80 mg/day) could cause a grave complication. More careful selection of the operative procedure might improve the mobidity rate.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ito
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ohga
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Nozoe
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ezaki
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D011300:Preoperative Care; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone