Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database

Abstract

Introduction: 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. Methods: 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. Results: 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). Conclusion: The study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality.