title: Preoperative glucocorticoid use and risk of postoperative bleeding and infection after gastric bypass surgery for the treatment of obesity.
abstract: BACKGROUND
  Previous research suggests that patients using glucocorticoids may be at increased risk of postoperative bleeding and infection after major surgery. The objective was to investigate the association between preoperative glucocorticoid use and risk of bleeding and infection after Roux-en-Y gastric bypass surgery (RYGB).
  
  
  METHODS
  Nationwide cohort study of 13,195 patients, who underwent RYGB 2006-2012 using Danish population-based medical databases.
  
  
  METHODS
  Information was obtained on current (redeemed prescription<60 d before surgery), recent (prescription 60-180 d before surgery), or no glucocorticoid use, and postoperative bleeding or infection within 30 days of surgery. We computed risk differences and odds ratios (ORs) as a measure of relative risk with 95% confidence intervals (95% CIs) for the association between glucocorticoid use and bleeding or infection, adjusting for gender, age, and co-morbidities by logistic regression.
  
  
  RESULTS
  Among RYGB patients, 325 (2.5%) were current glucocorticoid users, and 365 (2.8%) were recent users. The risk of bleeding was increased in current users: 2.8% versus 1.6% among nonusers (risk difference: 1.2%, 95% CI: -.6, 3.0) corresponding to an adjusted OR of 1.5 (95% CI: .8, 3.0). For recent users, the adjusted OR for bleeding was 1.2 (95% CI: .5, 2.5). The risk of infection did not differ materially between current (1.8%), recent (1.0%) and nonusers (1.7%), corresponding to an adjusted OR of .9 (95% CI: .4, 2.1) among current versus nonusers.
  
  
  CONCLUSIONS
  Current use of glucocorticoids is associated with a slightly increased risk of postoperative bleeding, but not infection, after RYGB. No increased risks were found for recent users.
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital. Electronic address: siggri@rm.dk.
authors.forename: Sigrid Bjerge
authors.initials: SB
authors.lastname: Gribsholt
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Svensson
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital.
authors.forename: Reimar Wernich
authors.initials: RW
authors.lastname: Thomsen
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Richelsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D003718:Denmark / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D011300:Preoperative Care / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Bariatric surgery; Bleeding; Cohort study; Glucocorticoids; Infection