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Impact of stress dose steroids on the outcomes of restorative proctocolectomy in ulcerative colitis

The latest issue of the Diseases of the Colon & Rectum evaluates the impact of stress dose steroids on the outcomes of restorative proctocolectomy in patients with ulcerative colitis.

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Stress dose steroids are administered during the perioperative period to prevent complications of secondary hypoadrenalism, which can occur after long-term steroid treatment.

Steroids also increase postoperative morbidity.

Patients with ulcerative colitis often require steroid therapy before definitive surgery and often receive perioperative steroids in a variety of doses.

89 patients received stress dose steroids
Diseases of the Colon & Rectum

Dr Erman Aytac and colleagues evaluated the impact of stress dose steroid administration on short-term postoperative outcomes after restorative proctocolectomy in patients with ulcerative colitis.

The team performed a retrospective cohort study in a high-volume, specialized colorectal surgery department.

Patients who had been treated with steroids for ulcerative colitis and underwent a restorative proctocolectomy from 2009 to 2011 were identified and categorized into 2 groups based on whether they received stress dose steroids.

The team compared both cohorts for patient demographics, duration of steroid treatment before surgery, and operative and postoperative outcomes.

The research team found that 89 patients received stress dose steroids, and 146 patients did not.

Stress dose steroids were more frequently administered to patients who were under steroid treatment immediately before restorative proctocolectomy.

A sinus tachycardia developed more frequently in patients who received stress dose steroids during surgery.

The researchers observed that 1 patient in the stress dose steroid group died on postoperative day 25 because of anastomotic leak.

Although no patients in either group had an adrenal crisis during surgery, 1 patient in the stress dose steroid group was diagnosed with adrenal insufficiency postoperatively.

Dr Aytac's concludes, "Although administration of stress dose steroids is not related to increased postoperative complications, the steroids do not appear to affect adrenal insufficiency outcomes."

"Patients who were treated with steroids for ulcerative colitis should be monitored carefully in the perioperative and early postoperative periods for signs of adrenal insufficiency, regardless of the steroid regimen used."

Dis Colon Rectum 2013: 56(11): 1253–1258
08 November 2013

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