Advertisement

Association between chronic steroids and outcomes in hepatobiliary and pancreatic surgery

Published:January 21, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.021

      Highlights

      • Steroids were associated with higher rates of poor outcomes in patients undergoing pancreatic or hepatobiliary surgery.

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Papis D.
        • Vagliasindi A.
        • Maida P.
        Hepatobiliary and pancreatic surgery in the elderly: current status.
        Ann Hepatobiliary Pancreat Surg. 2020 Feb; 24 (Epub 2020 Feb 27. PMID: 32181422; PMCID: PMC7061045): 1-5https://doi.org/10.14701/ahbps.2020.24.1.1
        • di Sebastiano P.
        • Festa L.
        • Büchler M.W.
        • di Mola F.F.
        Surgical aspects in management of hepato-pancreatico-biliary tumours in the elderly.
        Best Pract Res Clin Gastroenterol. 2009; 23 (PMID: 19942168): 919-923https://doi.org/10.1016/j.bpg.2009.10.003
        • Wang A.S.
        • Armstrong E.J.
        • Armstrong A.W.
        Corticosteroids and wound healing: clinical considerations in the perioperative period.
        Am J Surg. 2013 Sep; 206 (Epub 2013 Jun 4. PMID: 23759697): 410-417https://doi.org/10.1016/j.amjsurg.2012.11.018
        • MacLeod C.
        • Hadoke P.W.F.
        • Nixon M.
        Glucocorticoids: fuelling the fire of atherosclerosis or therapeutic extinguishers?.
        Int J Mol Sci. 2021 Jul 16; 22 (PMID: 34299240; PMCID: PMC8303333): 7622https://doi.org/10.3390/ijms22147622
        • Hai H.H.
        • Aw P.
        • Teng T.Z.J.
        • Shelat V.G.
        Perioperative steroid administration reduces overall complications in patients undergoing liver resection: a meta-analysis.
        World J Gastrointest Surg. 2021 Sep 27; 13 (PMID: 34621482; PMCID: PMC8462075): 1079-1094https://doi.org/10.4240/wjgs.v13.i9.1079
        • Whitlock Richard P.
        • Chan Simon
        • Devereaux P.J.
        • et al.
        Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials.
        Eur Heart J. November 2008; 29: 2592-2600https://doi.org/10.1093/eurheartj/ehn333
        • Aziz H.
        • Ahmed Z.
        • Abdimajid M.
        • Sekigami Y.
        • Hertl M.
        • Goodman M.D.
        Association between preoperative steroids and outcomes in patients undergoing pancreaticoduodenectomy using the national surgical quality improvement program.
        J Gastrointest Surg. 2022 Jun; 26 (Epub 2022 Feb 9. PMID: 35141835): 1198-1204https://doi.org/10.1007/s11605-022-05260-w
        • Ko C.Y.
        • Hall B.L.
        • Hart A.J.
        • Cohen M.E.
        • Hoyt D.B.
        The American College of Surgeons national surgical quality improvement program: achieving better and safer surgery.
        Joint Comm J Qual Patient Saf. 2015 May; 41 (PMID: 25977246): 199-204https://doi.org/10.1016/s1553-7250(15)41026-8
        • Subramanian V.
        • Saxena S.
        • Kang J.Y.
        • Pollok R.C.
        Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery.
        Am J Gastroenterol. 2008 Sep; 103 (PMID: 18616660): 2373-2381https://doi.org/10.1111/j.1572-0241.2008.01942.x.Epub.2008.Jul.4
        • Aziz H.
        • Kwon Y.I.C.
        • Alvi S.
        • et al.
        Does chronic use of steroids affect outcomes after liver resection? Analysis of a national database.
        J Gastrointest Surg. 2022; 26: 2093-2100https://doi.org/10.1007/s11605-022-05393-y
        • Chang Hui-Ru
        • Shih Shou-Chuan
        • Lin Fu-Man
        Impact of comorbidities on the outcomes of older patients receiving rectal cancer surgery.
        Int J Gerontol. 2012; 6 (ISSN 1873-9598): 285-289https://doi.org/10.1016/j.ijge.2012.05.006
        • Castle S.C.
        • Uyemura K.
        • Rafi A.
        • Akande O.
        • Makinodan T.
        Comorbidity is a better predictor of impaired immunity than chronological age in older adults.
        J Am Geriatr Soc. 2005; 53: 1565-1569https://doi.org/10.1111/j.1532-5415.2005.53512.x
        • Capussotti L.
        • Viganò L.
        • Giuliante F.
        • Ferrero A.
        • Giovannini I.
        • Nuzzo G.
        Liver dysfunction and sepsis determine operative mortality after liver resection.
        Br J Surg. 2009 Jan; 96: 88-94https://doi.org/10.1002/bjs.6429.PMID:19109799
        • Evans Laura
        • et al.
        Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.
        Crit Care Med. November 2021; 49 – Issue 11: e1063-e1143https://doi.org/10.1097/CCM.0000000000005337
        • Gianotti L.
        • Besselink M.G.
        • Sandini M.
        • et al.
        Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS).
        Surgery. 2018; 164: 1035-1048https://doi.org/10.1016/j.surg.2018.05.040
        • Jehan F.S.
        • Pandit V.
        • Khreiss M.
        • Joseph B.
        • Aziz H.
        Frailty predicts loss of independence after liver surgery.
        J Gastrointest Surg. 2022; 26: 2496-2502https://doi.org/10.1007/s11605-022-05513-8
        • Hockett D.
        • Rabinowitz J.B.
        • Kwon Y.K.
        • Joseph B.
        • Kaafarani H.
        • Aziz H.
        Critical appraisal of the quality of publications in hepatobiliary and pancreatic surgery research using the American College of Surgeons NSQIP database.
        J Am Coll Surg. 2022 Nov 11; (Epub ahead of print. PMID: 36367317)https://doi.org/10.1097/XCS.0000000000000477