BARIATRIC SURGERY OUTCOMES IN STEROID-DEPENDENT PATIENTS
Joshua Hefler*1, Jerry Dang1, Aryan Modasi1, Noah Switzer2, Daniel W. Birch1, Shahzeer Karmali1
1University of Alberta, Edmonton, AB, Canada; 2The Ohio State University, Columbus, OH
INTRODUCTION: The purpose of this study is to examine short-term outcomes of steroid-dependent patients undergoing bariatric surgery. Steroids are an essential component of treating a variety of autoimmune diseases, from rheumatoid arthritis to inflammatory bowel disease. Patients requiring long term treatment may become steroid dependent due to chronic adrenal suppression, even once their disease has become quiescent. Steroids themselves can contribute to weight gain and obesity. In the post-operative period, chronic steroid use can predispose patients to infection, wound breakdown and issues with blood pressure and glucose control. While bariatric surgery is by no means contraindicated in these patients, it is essential to adequately characterize their risks.
METHODS & PROCEDURES: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry was used to identify steroid-dependent patients who had undergone bariatric surgery. Patients undergoing primary bariatric surgery (laparoscopic Roux-en-Y gastric bypass [LRYGB] or laparoscopic sleeve gastrectomy [LSG]) at an accredited institution between 2015 and 2017 were included. A multivariable regression analysis was performed, controlling for age, sex, procedure and several other comorbidities. Overall 30-day incidence of major complications was the primary outcome. A secondary analysis compared outcomes amongst steroid-dependent patients by procedure type using a propensity-matched analysis.
RESULTS: Our primary analysis included a total of 430,936 patients undergoing bariatric surgery. Of these, 7,214 (1.67%) had chronic use of steroids. The absolute rates of major complications was 3.46% for non-steroid-dependent patients compared to 5.61% for steroid-dependent patients (p<0.001). Based on our multivariable model, we found the odds ratio of major complications between these cohorts was 1.39 (95%CI 1.25-1.55, p<0.001). Our secondary analysis, found that serious complications were statistically higher amongst steroid-dependent patients undergoing LRYGB (9.62% vs. 4.99%, p<0.001). However, incidence of mortality was the same between these patients (0.29% vs. 0.12%, p=0.256).
CONCLUSIONS: Steroid-dependent patients are at higher risk of major complications following bariatric surgery. This risk is even higher for patients undergoing LRYGB compared to LSG. Whether the risk to these patients is prohibitively high will depend on surgeon and patient comfort. Certainly more care is required in the selection of these patients and in their perioperative care compared to other patient populations.
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