Key result
Preoperative chronic steroid use in orthopedic surgery was associated with increased 30-day overall complications (aOR 1.42; 95% CI 1.16-1.75) and infections, but not 30-day mortality.
Why the study?
Although preoperative chronic steroid use has been linked to higher rates of postoperative complications, its specific effects on outcomes after orthopedic surgery remained unclear.
Does preoperative chronic steroid use increase adverse postoperative outcomes in patients undergoing orthopedic surgery?
Meta-Analysis (n=1,546,562)
Does preoperative chronic steroid use increase adverse postoperative outcomes in patients undergoing orthopedic surgery?
Odds Ratio: 1.4 (95% CI 0.64–3.09)
Preoperative chronic steroid use significantly increases the risk of postoperative complications, infections, and re-admissions following orthopedic surgery.
Supports heightened perioperative vigilance in chronic steroid users; leaves open whether tapering or alternatives reduce complications.
Higher rates of postoperative complications have been found in preoperative chronic steroid users. However, the effects of preoperative chronic steroid use on outcomes in orthopedic surgery were unclear. We performed a systematic review of cohort studies examining the effects of chronic steroid use on postoperative outcomes following orthopedic surgery and searched PubMed, Embase, and CENTRAL through 29 April 2023. We included 17 studies with 1,546,562 patients. No increase in 30-day mortality (adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 0.64-3.09) and composite thromboembolic events (aOR 1.61, 95% CI 0.99-2.63) but increases in 30-day overall complications (aOR 1.42, 95% CI 1.16-1.75), wound dehiscence (aOR 2.91, 95% CI 1.49-5.66), infectious complications (any infection (aOR 1.61, 95% CI 1.44-1.80), sepsis (aOR 2.07, 95% CI 1.34-3.21), superficial surgical site infection (SSI) (aOR 1.73, 95% CI 1.03-2.89) and deep SSI (aOR 1.96, 95% CI 1.26-3.05)), re-admission (aOR 1.62, 95% CI 1.48-1.77), both 30-day (aOR 1.28, 95% CI 1.03-1.59) and 1-year re-operation (aOR 1.78, 95% CI 1.09-2.92), pulmonary embolism (aOR 5.94, 95% CI 1.52-23.29), and deep vein thrombosis (aOR 2.07, 95% CI 1.24-3.46) were detected in preoperative steroid users. An increased risk of adverse outcomes following orthopedic surgery in chronic steroid users was found.
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Hung et al. (2023) conducted a meta-analysis in Orthopedic surgery (n=1,546,562). Preoperative chronic steroid use vs. No chronic steroid use was evaluated on 30-day mortality (aOR 1.40, 95% CI 0.64-3.09). Preoperative chronic steroid use in orthopedic surgery was associated with increased 30-day overall complications (aOR 1.42; 95% CI 1.16-1.75) and infections, but not 30-day mortality.
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