Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA.
The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Gastrointest Surg. 2022 Oct;26(10):2093-2100. doi: 10.1007/s11605-022-05393-y. Epub 2022 Jul 1.
With the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes.
We performed a retrospective review of the 2014-2019 NSQIP database of all patients undergoing liver resections. Propensity score matching was utilized to match the two groups (chronic steroids vs. no steroids) based on demographics, preoperative laboratory data, and operative findings. The primary outcome measure was mortality.
There were 712 patients in the chronic steroid group and 21,751 in the no steroid group. After propensity score matching; there were 420 patients in both groups. Post-match analysis again demonstrated that patients on chronic steroids were at higher risk of cardiac arrest than those not on steroids (OR 2.01, 95% CI 1.02-2.45, p = 0.04). In addition, rates of organ space wound infection (OR 2.66, CI 1.33-5.38, p = 0.03), superficial wound infection (OR 2.79, CI 1.08-5.41, p = 0.035), renal insufficiency (OR 1.25, CI 1.03-1.62, p = 0.02), postoperative sepsis (OR 1.28, CI 1.08-1.82, p = 0.04), DVT (OR 1.7, CI 1.01-2.82, p = 0.04), and bile leakage (OR 1.75, CI 1.24-3.36, p = 0.04) were also increased in patients on steroids. However, the matched cohorts were similar in postoperative mortality rates (OR 0.11, CI 0.6-1.17, p = 0.72).
The study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality.
随着患者年龄的增长，越来越多的慢性术前使用类固醇的患者接受了肝切除术。我们的研究旨在评估术前类固醇与结局之间的关系。
我们对 2014 年至 2019 年 NSQIP 数据库中所有接受肝切除术的患者进行了回顾性研究。根据人口统计学、术前实验室数据和手术结果，利用倾向评分匹配将两组（慢性类固醇组与无类固醇组）进行匹配。主要结局指标为死亡率。
慢性类固醇组有 712 例患者，无类固醇组有 21751 例患者。经过倾向评分匹配后，两组各有 420 例患者。再次进行匹配后分析表明，接受慢性类固醇治疗的患者发生心脏骤停的风险高于未接受类固醇治疗的患者（OR 2.01，95%CI 1.02-2.45，p=0.04）。此外，器官间隙感染（OR 2.66，CI 1.33-5.38，p=0.03）、浅表伤口感染（OR 2.79，CI 1.08-5.41，p=0.035）、肾功能不全（OR 1.25，CI 1.03-1.62，p=0.02）、术后脓毒症（OR 1.28，CI 1.08-1.82，p=0.04）、深静脉血栓形成（OR 1.7，CI 1.01-2.82，p=0.04）和胆漏（OR 1.75，CI 1.24-3.36，p=0.04）的发生率在接受类固醇治疗的患者中也有所增加。然而，两组患者术后死亡率相似（OR 0.11，CI 0.6-1.17，p=0.72）。
本研究发现，接受慢性术前类固醇治疗的肝切除术患者的发病率较高，但死亡率无差异。
