title: Expanded indications for bariatric surgery: should patients on chronic steroids be offered bariatric procedures?
abstract: BACKGROUND
  Patients who take chronic corticosteroids are increasingly referred for bariatric surgery. Little is known about their clinical outcomes.
  
  
  OBJECTIVE
  Determine whether chronic steroid use is associated with increased morbidity and mortality after stapled bariatric procedures.
  
  
  METHODS
  American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
  
  
  METHODS
  All patients who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass and were reported to the ACS-NSQIP from 2011 to 2013 were reviewed. Patients were grouped based on type of surgery and history of chronic steroid use. Primary outcome measures were mortality and serious morbidity in the first 30 days. Regression analyses were used to determine predictors of outcome.
  
  
  RESULTS
  Of 23,798 patients who underwent laparoscopic sleeve gastrectomy and 38,184 who underwent Roux-en-Y gastric bypass, 385 (1.6%) and 430 (1.1%), respectively, were on chronic steroids. Patients on chronic steroids had a 3.4 times increased likelihood of dying within 30 days (95% confidence interval 1.4-8.1, P = .007), and 2-fold increased odds of serious complications (95% confidence interval 1.2-2.3, P = .008), regardless of surgery type. In multivariate regression, steroid usage remained an independent predictor of mortality and serious complications.
  
  
  CONCLUSIONS
  In a large, nationally representative patient database, steroid use independently predicted mortality and serious postoperative complications after stapled bariatric procedures. Surgeons should be cautious about offering stapled bariatric procedures to patients on chronic steroids.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California. Electronic address: Jenny.Kaplan@ucsf.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Kaplan
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Schecter
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Rogers
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Matthew Y C
authors.initials: MYC
authors.lastname: Lin
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Posselt
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, California.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods / Q000401:mortality; D002908:Chronic Disease; D003695:Delivery of Health Care; D048909:Diabetes Complications / Q000150:complications; D004417:Dyspnea / Q000150:complications; D005260:Female; D005743:Gastrectomy / Q000379:methods / Q000401:mortality*; D015390:Gastric Bypass / Q000379:methods / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery; D018579:Patient Selection; D011183:Postoperative Complications / Q000139:chemically induced / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects*; D017792:Surgical Stapling; D055815:Young Adult
chemical_list: D013256:Steroids
keywords: Bariatric surgery; Morbidity; Mortality; Outcomes; Predictors; Steroids
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