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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pulmonary embolism.Lancet. 2004; 363: 1295-1305
- Making health care safer: a critical analysis of patient safety practices.Evid Rep Technol Assess (Summ). 2001; ([1-668.]): i-x
- Venous thromboembolism: annualised United States models for total, hospital-acquired and preventable costs utilising long-term attack rates.Thromb Haemost. 2012; 108: 291-302
- Venous thromboembolism pharmacy intervention management program with an active, multifaceted approach reduces preventable venous thromboembolism and increases appropriate prophylaxis.Clin Appl Thromb Hemost. 2012; 18: 45-58
- Risk factors for venous thromboembolism.Circulation. 2003; 107: I9-I16
- Coagulopathy in Cushing's syndrome.Neuroendocrinology. 2010; 92: 55-59
- Systematic review on the effect of glucocorticoid use on procoagulant, anti-coagulant and fibrinolytic factors.J Thromb Haemost. 2010; 8: 2483-2493
- The NSQIP: a new frontier in surgery.Surgery. 2005; 138: 837-843
- The patient safety in surgery study: background, study design, and patient populations.J Am Coll Surg. 2007; 204: 1089-1102
- The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility.Ann Surg. 2002; 236 ([discussion 353–4]): 344-353
- Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case–control study.JAMA Intern Med. 2013; 173: 743-752
- Use of oral glucocorticoids and the risk of pulmonary embolism: a population-based case–control study.Chest. 2013; 143: 1337-1342
- Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration.Blood. 2003; 101: 2529-2533
- Endothelial stress products and coagulation markers in patients with multiple myeloma treated with lenalidomide plus dexamethasone: an observational study.Br J Haematol. 2013; 160: 351-358
- Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP.Dis Colon Rectum. 2012; 55: 1138-1144
- Risk factors and clinical impact of postoperative symptomatic venous thromboembolism.J Vasc Surg. 2007; 45 ([discussion 341–2]): 335-341
- Reduced fibrinolytic potential one year after kidney transplantation. Relationship to long-term steroid treatment.Transplantation. 1995; 59: 1416-1420
- Glucocorticoids and insulin promote plasminogen activator inhibitor 1 production by human adipose tissue.Diabetes. 1999; 48: 890-895
Article info
Publication history
Published online: July 03, 2015
Accepted:
June 12,
2015
Received in revised form:
June 12,
2015
Received:
June 3,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
