Perioperative steroid use in colorectal patients

PURPOSE: A survey was conducted to document current perioperative steroid use in colorectal patients. METHODS: A mail survey was sent to 1,400 members and fellows of The American Society of Colon and Rectal Surgeons. RESULTS: Three hundred seven questionnaires (21.9 percent) were returned. Twenty-four respondents had retired or lacked accurate data. The remaining 283 surgeons averaged 43.5 (range, 31-71) years in age and had been in practice an average of 11 (range, 1-39) years. Ninety-seven percent were certified by the American Board of Surgery, 87 percent by the American Board of Colon and Rectal Surgery, and 85 percent by both. Eighty-six percent of respondents manage the perioperative steroids and 85 percent manage the postoperative steroid taper of their patients. In patients receiving preoperative steroids, 84 percent of respondents administer 100 mg of hydrocortisone phosphate intravenously before surgery. The most common postoperative dosage (used by 62 percent) was 100 mg of hydrocortisone phosphate intravenously every eight hours, which was tapered to 50 mg intravenously every 8 to 12 hours. Most patients (49 percent) received 20 mg of prednisone per day when their oral intake was resumed. The most common taper regimen was a 5 mg reduction per week (61 percent of respondents). CONCLUSION: Despite lack of scientifically established requirements or proven physiologic guidelines, perioperative steroid use by colorectal surgeons appears relatively consistent.