Document Detail


Preoperative prolonged steroid use is not associated with intraoperative blood transfusion in noncardiac surgical patients.
MedLine Citation:
PMID:  20613467     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prolonged steroid therapy is reportedly associated with changes in coagulation, suggesting increased intraoperative bleeding or hypercoagulability. The aim of this retrospective study was to assess whether long-term steroid use was associated with increased transfusion requirements, infection, or hypercoagulability in adults undergoing noncardiac surgery. METHODS: In this study the authors evaluated 363,897 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Patients with current pneumonia, ventilator dependence, coma, tumor involving the central nervous system, disseminated cancer, preoperative open wound/wound infection, and/or bleeding disorders were excluded. Each steroid user was matched to a nonsteroid user based on propensity score and type of surgery. RESULTS: 296,059 patients met the inclusion criteria, of whom 7,760 (2.6%) were taking steroids preoperatively. The incidence of intraoperative erythrocyte transfusion was 3.6% in the steroid user and 7.3% in non-steroid-user groups. After matching, the mean [95% confidence interval] number of units transfused was 0.22 [0.19, 0.25] units in the nonsteroid group and 0.19 [0.17, 0.22] units in the steroid group which was not statistically significant (P = 0.24, Wald test). Steroid users were 24% [2, 49] more likely to experience 30-day postoperative systemic infection and 21% [3, 41] more likely to experience postoperative wound infection than nonusers. The risks of postoperative thromboembolic complications did not differ significantly. CONCLUSIONS: The effect of prolonged steroid use on bleeding, if any, thus seems likely to be small and is probably of limited clinical consequence. In contrast, corticosteroid use augments the risk of both systemic and wound infections.
Authors:
Alparslan Turan; Jarrod E Dalton; Patricia L Turner; Daniel I Sessler; Andrea Kurz; Leif Saager
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  113     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-08-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  285-91     Citation Subset:  AIM; IM    
Affiliation:
Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA. alparslanturan@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage*,  adverse effects
Adult
Aged
Blood Loss, Surgical / prevention & control
Blood Transfusion* / utilization
Digestive System Surgical Procedures* / adverse effects
Drug Administration Schedule
Female
Humans
Intraoperative Complications / chemically induced,  epidemiology,  therapy*
Male
Middle Aged
Preoperative Care* / adverse effects
Prospective Studies
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones
Comments/Corrections
Comment In:
Anesthesiology. 2010 Aug;113(2):268-70   [PMID:  20571356 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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