Steroids increase risk for postoperative complications in ulcerative colitis patients: 6 study findings

Researchers in Canada found using steroids before ulcerative colitis surgery is associated with a higher risk for postoperative sepsis and clotting, Gastroenterology & Endoscopy news reported.

The researchers used the American College of Surgeons National Surgical Quality Improvement Program database to identify 2,736 patients with ulcerative colitis who had ileal pouch-anal anastomosis surgery between 2005 and 2012, comparing postoperative complications and 30-day mortality for patients who received steroids before surgery and those who didn't. Within 30 days of the operation, 1,104 patients took steroids.

The researchers presented their findings at the 2018 Canadian Digestive Diseases Week conference.

Here are the key findings:

1. In the group exposed to steroids before surgery, 26.2 percent experienced major postoperative complications, and 32.7 percent experienced overall postoperative complications.

2. Preoperative steroid use was also associated with a higher 30-day reoperation rate compared to those who did not take steroids (8.2 percent compared to 5.6 percent). Patients who used steroids before surgery also had a slightly longer length of stay at 8.1 days compared to 7.5 days for those who didn't use steroids.

3. The difference is driven by complications such as pouch-related septic complications and thromboembolic complication, the authors said.

4. When adjusting for age, sex, body mass index and smoking status, preoperative steroid use was associated with a greater risk for postoperative complications.

5. The researchers recommended using a two-step procedure in the patient population. " In the past few years, there's been a move toward the single-step procedure for IPAA, which has been shown to be safe and effective in selected patients," said Amir Rumman, MD, a gastroenterologist at the University of Toronto in the report. "These findings suggest that if you are on steroids and need pouch surgery, you’re probably better off doing it as a two-step procedure."

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