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The effect of chronic steroid therapy on outcomes following cardiac surgery: a propensity-matched analysis
Krishnanand R Pai1, Ian R Ramnarine, Antony D Grayson
1Department of Cardiothoracic Surgery, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. kardiac_pai@rediffmail.com
Objective:
Steroids are beneficial in reducing the inflammatory response accompanying surgery with cardiopulmonary bypass. However, chronic steroid therapy has been implicated as a risk factor for abdominal complications and mortality following surgery. We assessed the impact of chronic steroid therapy had on outcome following cardiac surgery.
Methods:
During the period January 1999 to March 2003 there were 98 patients on chronic steroid therapy (Group S) who underwent cardiac surgery at our institution. These patients were matched with a control group of 98 patients who were not on steroids (Group C). A propensity score was used to perform the matching. The C statistic for this model was 0.72.
Results:
Ninety (93.7%) of the 98 patients in Group S had been on oral prednisolone for a median of 9.5 years (25th and 75th percentile of 5 and 12 years) with a median dose of 5mg (25th and 75th percentile of 4 and 8.75 mg). Preoperative characteristics were well matched between both groups. There was no difference in the post-operative outcome between the two groups with respect to mortality, stroke, renal failure, abdominal complications, wound infections, requirement for inotropic support and myocardial infarction. Patients in Group S were more likely to develop atrial arrhythmias and to require prolonged ventilation, although this did not reach statistical significance.
Conclusions:
Chronic steroid therapy was not associated with increased mortality or overall morbidity following cardiac surgery. However, patients on chronic steroids may be at greater risk of developing atrial arrhythmias or of requiring prolonged ventilation.
