Chronic steroid use has been associated with increased postoperative complication;
however, the association between chronic steroids and hepatobiliary and pancreatic
surgery through all aspects of disease etiologies and types of surgery performed remains
an area of active research. Therefore, this study analyzed the association of chronic
steroids use with outcomes after hepatobiliary and pancreatic surgery.
The National Surgical Quality Improvement Program Participant Use Data Files for hepatobiliary
and pancreatic surgeries performed between 2015 and 2019 were analyzed for chronic
steroid use and postoperative adverse events.
A total of 54,382 patients underwent hepatobiliary or pancreatic surgery during the
study period, of which 1672 (3.1%) were on chronic steroids. In patients undergoing
pancreatic surgery, steroid use was associated with higher rates of pneumonia (odds
ratio [OR] 1.3, 95% confidence interval [95% CI] 1.2–2.2), unplanned intubation (OR
1.2, 95% CI 1.1–2.3), readmission (OR 1.4, 95% CI 1.3–2.4), intraoperative or postoperative
transfusions (OR 1.5, 95% CI 1.2–2.3), being more likely to remain on a ventilator
for greater than 48 h (OR 1.4, 95% CI 1.2–1.9), and greater mortality (OR 1.2, 95%
CI 1.1–3.1) when compared to those, not on chronic steroids. In patients undergoing
hepatobiliary surgery, chronic steroid use was associated with higher rates of sepsis
(OR 1.3, 95% CI 1.2–2.9), unplanned intubation (OR 1.4, 95% CI 1.2–2.7), intraoperative
or postoperative transfusions (OR 1.5, 95% CI 1.3–2.3), and readmission (OR 1.2, 95%
CI 1.0–1.9). There was no difference in pancreatic fistula rates or post-hepatectomy
liver failure rates after pancreatic and hepatobiliary resections, respectively.
Chronic steroids use was associated with higher rates of poor outcomes both perioperatively
and postoperatively in pancreatic and hepatobiliary surgery. These results will allow
clinicians to be better equipped to counsel patients on surgery's increased risks
and establish various perioperative protocols for chronic steroid users.