title: Preadmission glucocorticoid use and anastomotic leakage after colon and rectal cancer resections: a Danish cohort study.
abstract: OBJECTIVE
  To examine whether preadmission glucocorticoid use increases the risk of anastomotic leakage after colon and rectal cancer resections.
  
  
  METHODS
  A population-based cohort study.
  
  
  METHODS
  Denmark (2001-2011).
  
  
  METHODS
  We identified patients who had undergone a primary anastomosis after a colorectal cancer resection by linking medical registries. Participants who filled their most recent glucocorticoid prescription ≤90, 91-365 and >365 days before their surgery date were categorised as current, recent and former users, respectively.
  
  
  METHODS
  We calculated 30-day absolute risk of anastomotic leakage and computed ORs using logistic regression models with adjustment for potential confounders.
  
  
  RESULTS
  Of the 18,190 patients with colon cancer, anastomotic leakage occurred in 1184 (6.5%). Glucocorticoid use overall was not associated with an increased risk of leakage (6.4% vs 6.9% among never-users; OR 1.05; 95% CI 0.89 to 1.23). Categories of oral, inhaled or intestinal-acting glucocorticoids did not greatly affect risk of leakage. Anastomotic leakage occurred in 695 (13.2%) of 5284 patients with rectal cancer. Glucocorticoid use overall slightly increased risk of leakage (14.6% vs 12.8% among never-users; OR 1.36, 95% CI 1.08 to 1.72). Results did not differ significantly within glucocorticoid categories.
  
  
  CONCLUSIONS
  Preadmission glucocorticoids modestly increased the risk of anastomotic leakage mainly after rectal cancer resection. However, absolute risk differences were small and the clinical impact of glucocorticoid use may therefore be limited.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Eva Bjerre
authors.initials: EB
authors.lastname: Ostenfeld
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Rune
authors.initials: R
authors.lastname: Erichsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
authors.affiliation: Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Thorlacius-Ussing
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lene Hjerrild
authors.initials: LH
authors.lastname: Iversen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Anders H
authors.identifier: http://orcid.org/0000-0002-6684-4068
authors.initials: AH
authors.lastname: Riis
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011300:Preoperative Care / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005938:Glucocorticoids
keywords: EPIDEMIOLOGY