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Venous thromboembolism and preoperative steroid use: Analysis of the NSQIP database to evaluate risk in surgical patients

  • Author Footnotes
    1 These authors contributed equally.
    Rami S. Kantar
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Experimental Therapeutics and Molecular Imaging Laboratory, Massachusetts General Hospital, Boston, USA
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  • Author Footnotes
    1 These authors contributed equally.
    Anthony G. Haddad
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

    Department of Surgery, Brigham and Women's Hospital, Boston, USA
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  • Hani Tamim
    Affiliations
    Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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  • Faek Jamali
    Affiliations
    Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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  • Ali T. Taher
    Correspondence
    Corresponding author at: Division of Hematology & Oncology, Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon. Tel.: +961 1 350000 (international); fax: +961 1 370814 (international).
    Affiliations
    Experimental Therapeutics and Molecular Imaging Laboratory, Massachusetts General Hospital, Boston, USA
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  • Author Footnotes
    1 These authors contributed equally.

      Highlights

      • Links between preoperative glucocorticoids and postoperative VTE are unexplored.
      • Prolonged preoperative glucocorticoid intake is associated with postoperative VTE.
      • Preoperative glucocorticoid intake is linked to other postoperative outcomes.
      • The risk of glucocorticoid intake on postoperative VTE warrants more investigation.

      Abstract

      Background

      Despite several prophylactic strategies, postoperative venous thromboembolism (VTE) remains a major cause of morbidity and mortality. Therefore, the search for modifiable preoperative risk factors is crucial. Few reports have explored this issue but the direct relationship between preoperative steroid use and postoperative VTE in surgical patients remains unexplored.

      Methods

      We used The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database in our study. After analyzing patient characteristics, we used multivariate logistic regression to assess the crude and adjusted effect of steroids on VTE, our primary outcome.

      Results

      Data was obtained for 1,921,901 patients, 58,667 of whom were on glucocorticoids for at least 30 days preoperatively. VTE was higher in patients on steroids with an adjusted odds ratio of 1.54, 95% confidence interval (CI) 1.45–1.64. The adjusted odds ratio for the secondary outcomes: mortality, urinary tract occurrences, wound occurrences, sepsis, cardiac and respiratory adverse events were 1.42 (CI 1.35–1.49), 1.40 (CI 1.30–1.50), 1.58 (CI 1.51–1.66), 1.51 (CI 1.42–1.60), 1.19 (CI 1.11–1.29) and 1.302 (CI 1.301–1.303) respectively.

      Conclusions

      Our results suggest that surgical patients with prolonged preoperative glucocorticoid intake are at a higher risk of developing postoperative VTE as well as other secondary outcomes including: all-cause mortality, urinary tract occurrences, sepsis, wound occurrences, cardiac and respiratory adverse events. These are important findings since preoperative glucocorticoid use is a modifiable factor.

      Keywords

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