title: The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease.
abstract: BACKGROUND
  Inflammatory 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  We 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).
  
  
  CONCLUSIONS
  Preoperative steroids are associated with higher risk of postoperative sepsis and VTE in IBD. Increased infectious control measures and VTE prophylaxis may reduce adverse events.
authors.affiliation: Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Canada. Electronic address: geoff.nguyen@utoronto.ca.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nguyen
authors.affiliation: University Health Network, Division of General Surgery, Department of Surgery, University of Toronto, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Elnahas
authors.affiliation: University Health Network, Division of General Surgery, Department of Surgery, University of Toronto, Canada.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Corticosteroids; Crohn's disease; Inflammatory bowel disease; Postoperative complications; Surgery; Ulcerative colitis