Effects of Preoperative Steroid Use on Postoperative Outcomes in Reconstructive Pelvic Surgery

INTRODUCTION: Chronic steroid use has been cited as a risk factor associated with increased postoperative morbidity and impaired wound healing in various surgical fields. The association of chronic steroid use within the field of urogynecology has not been well defined to date. OBJECTIVE: The objective of this analysis was to compare the association of chronic steroid use on 30-day perioperative complications after reconstructive pelvic surgery (RPS) for patients with pelvic organ prolapse (POP). METHODS: This was a retrospective database analysis of the National Surgical Quality Improvement Program (NSQIP) database for the years 2015 through 2020. Cases were selected using International Classification of Disease (ICD-10) codes that reflected diagnosis codes for POP and with Current Procedural Terminology (CPT) codes for RPS. Chronic steroid use was defined as regular administration of parenteral or oral corticosteroid administration within the 30-day preoperative period before surgery. Chi-square tests, independent t-tests, and Mann–Whitney U tests were used to compare major and minor complication rates between groups. A P value of <0.05 was used to determine significance. RESULTS: 49,903 cases were identified, of which 1054 (2.1%) were identified as using chronic steroids. Patients using steroids were on average older (63.51 ± 11.5 vs 61.41 ± 12.21). Patients using chronic steroids were more likely to have preoperative dyspnea (6.2% vs 2.5%, p<0.001). Patients using chronic steroids had higher occurrences of organ/space SSI (1.1% vs 0.6%, p=0.14), pulmonary embolism (0.5% vs 0.1%, p<0.001), and postoperative readmission (3.6% vs 2.1%, p<0.001). There were higher rates of UTI among patients using chronic steroids, but this did not reach statistical significance (5.8% vs 4.6%, p=.074). Otherwise, there were no statistically significant differences among rates of superficial surgical site infection, deep incisional surgical site infection, wound disruption, pneumonia, unplanned intubation, progressive renal failure, cardiac arrest, myocardial infarction, blood transfusions, sepsis, septic shock, or DVT/thrombophlebitis. CONCLUSIONS: Chronic steroid use prior to surgery is not a common risk factor among patients undergoing RPS, and among those characterized as chronic steroid users, the general rate of complication after surgery was low. Although rates of organ/space surgical site infection and pulmonary embolism were higher among the chronic steroid group, the limited number of patients in this cohort makes it difficult to generalize conclusions.