title: Effect of perioperative systemic steroid treatment on patients with obstructive lung disease undergoing elective abdominal surgery.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease is an independent risk factor of postoperative pulmonary complications (PPCs). It is unknown whether a perioperative systemic corticosteroid would be beneficial in patients with obstructive airway disease.
  
  
  OBJECTIVE
  The present study was conducted to determine the effect of a perioperative systemic corticosteroid on PPCs in patients who showed airway obstruction in preoperative spirometry.
  
  
  METHODS
  Retrospective medical record reviews were performed on records from January 2010 to December 2011 in a referral hospital. We analyzed the data of patients who were referred to pulmonologists before elective abdominal surgery and had a prebronchodilator FEV1/FVC of <70%. We compared the PPCs between the steroid group and the non-steroid group.
  
  
  RESULTS
  A total of 270 patients were referred to pulmonologists and, of these, 86 had a FEV1/FVC of <70% in the preoperative spirometry. In the 30 patients in the steroid group, the mean FEV1 was 52.2% and half of these had previously used a bronchodilator. Use of a perioperative systemic corticosteroid was significantly associated with reduced incidence of PPCs in the multivariate logistic regression with adjustment by propensity score (adjusted odds ratio = 0.036, 95% confidence interval [CI] = 0.003-0.505; P = 0.014).
  
  
  CONCLUSIONS
  In our retrospective study we showed that those treated with steroids had better outcomes. However, future prospective and randomized controlled trials are needed.
authors.affiliation: Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Kyu
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Medical Statistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: So Hee
authors.initials: SH
authors.lastname: Oh
authors.affiliation: Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Deog Kyeom
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hee Soon
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Heo
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000280:Administration, Inhalation; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D029424:Pulmonary Disease, Chronic Obstructive; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids
keywords: chronic obstructive pulmonary disease; corticosteroid; perioperative period; postoperative complication; surgery