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Risk of peri-operative complications in children receiving preoperative steroids
Elbert J Mets1, Fouad Chouairi1, Humza Mirza1
1Department of Surgery, Section of Plastic Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, 3rd Floor, New Haven, CT, 06510, USA.
Insights
Preoperative steroid use in children significantly increases the risk of adverse surgical outcomes. This includes longer hospital stays, seizures, readmissions, and even death, highlighting the need for careful risk-benefit evaluation.
Area of Science:
- Pediatric Surgery
- Pharmacology
- Patient Safety
Background:
- Steroid use is known to increase perioperative complications in adults.
- Limited research exists on the perioperative effects of steroid use in pediatric surgical patients.
Purpose of the Study:
- To investigate the impact of preoperative steroid use on adverse events in pediatric surgery.
- To compare outcomes between pediatric surgical patients who received preoperative steroids and those who did not.
Main Methods:
- Utilized the National Surgical Quality Improvement Project Pediatric Database (2012-2017).
- Identified pediatric patients receiving preoperative steroids.
- Performed propensity score matching to compare 30-day adverse events between steroid and non-steroid cohorts.
Main Results:
- 2.3% of 425,251 pediatric surgery patients received preoperative steroids.
- Steroid group had higher rates of prolonged hospital stay (15.3% vs. 9.1%), seizure (0.9% vs. 0.4%), readmission (14.4% vs. 9.2%), and death (2.2% vs. 1.1%).
- Steroid use was independently associated with increased adverse events after propensity score matching.
Conclusions:
- Preoperative steroid administration is linked to a higher incidence of 30-day postoperative adverse events in children.
- Careful consideration of steroid risks versus benefits is crucial for pediatric surgical patients.
- Further evaluation of steroid treatment protocols in pediatric surgery is warranted.
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.
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