The reduced risk of septic shock/sepsis with laparoscopic surgery among ulcerative colitis patients with preoperative chronic steroid use
| Autor: | Tiffany Brocke, Bashar Safar, Miloslawa Stem, Jonathan E. Efron, George Q. Zhang, Brian D. Lo, Chady Atallah, Oluseye Oduyale |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Laparoscopic surgery medicine.medical_specialty medicine.medical_treatment 030230 surgery Risk Assessment Drug Administration Schedule Cohort Studies Sepsis 03 medical and health sciences Postoperative Complications 0302 clinical medicine Risk Factors Preoperative Care Humans Medicine Glucocorticoids Colectomy Retrospective Studies business.industry Septic shock Incidence Odds ratio Middle Aged medicine.disease Shock Septic Ulcerative colitis United States Confidence interval Surgery Survival Rate Elective Surgical Procedures Steroid use 030220 oncology & carcinogenesis Colitis Ulcerative Female Laparoscopy business |
| Zdroj: | Surgery. 170:1047-1053 |
| ISSN: | 0039-6060 |
| Popis: | BACKGROUND Preoperative steroid use has been associated with worse surgical outcomes. The purpose of this study was to determine whether laparoscopic surgery reduces the risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use. METHODS Patients with ulcerative colitis undergoing a total abdominal colectomy were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2019). Patients were stratified based on preoperative chronic steroid use and operative approach (open versus laparoscopic). The primary outcome was septic shock/sepsis. Multivariable regression models were used to assess the association between laparoscopic surgery and rates of septic shock/sepsis among steroid users and non-steroid users in both the elective and emergent settings. RESULTS Among 8,644 patients undergoing a total abdominal colectomy, 67.1% were steroid users and 32.9% were non-steroid users. Compared with an open approach, elective laparoscopic surgery was associated with lower rates of septic shock/sepsis, albeit with higher readmission rates for both steroid users (15.1% [laparoscopic] vs 12.0% [open], P = .005) and non-steroid users (12.6% [laparoscopic] vs 9.4% [open], P = .019). On adjusted analysis, ulcerative colitis patients with chronic steroid use undergoing an elective laparoscopic total abdominal colectomy demonstrated a reduced risk of septic shock/sepsis compared to open surgery (odds ratio 0.61, 95% confidence interval 0.49-0.76, P < .001). Similar findings were seen among chronic steroid users undergoing emergent laparoscopic procedures (odds ratio 0.54, 95% confidence interval 0.31-0.95, P = .031). CONCLUSION Laparoscopic surgery was associated with a reduced risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use, suggesting that minimally invasive surgery may be a promising option among this unique patient population. |
| Databáze: | OpenAIRE |
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