Risk of peri-operative complications in children receiving preoperative steroids
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In brief
In brief
This NSQIP database study of 425,251 pediatric surgical patients found that preoperative steroid use independently increases risk of 30-day complications including prolonged hospitalization, seizures, readmission, and mortality. The findings suggest careful risk-benefit evaluation is needed when considering steroid therapy in children undergoing surgery.
Written by the GCMD Library team from the article.
Abstract
Background
Steroid use predisposes adult patients to increased perioperative complications including wound dehiscence and delayed wound healing. A similar large study investigating the perioperative impact of steroid use in pediatric patients has not been performed.
Methods
The National Surgical Quality Improvement Project Pediatric Database was queried from 2012–2017 to identify patients who received steroid preoperatively. Patient demographics, comorbidities, surgical variables, and outcomes were compared between cohorts. Patients were propensity score matched and thirty-day adverse events were compared.
Results
Of 425,251 pediatric surgery patients, 9716 (2.3%) received preoperative steroids. Pediatric patients treated with steroids were older and had more comorbidities. After propensity score matching, the steroid population had a significantly higher rate of adverse events, including prolonged hospital stay (15.3% vs. 9.1%, p < 0.001), seizure (0.9% vs. 0.4%, p < 0.001), readmission (14.4% vs. 9.2%, p < 0.001), and death (2.2% vs. 1.1%, p < 0.001).
Conclusion
Preoperative steroid use is independently associated with increased 30-day postoperative adverse events among pediatric patients. Given the significant impact of steroid use on surgical outcomes, the risks and benefits of steroid treatment in children receiving surgery should be carefully evaluated.