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Perioperative Steroids Safe in Patients with Pulmonary Disease Undergoing Cardiac Surgery: Presented at ASA
By Alison Palkhivala
Special to DG News
NEW ORLEANS, LA -- October 17, 2001 -- Perioperative short-term use of steroids does not increase the risk of infections in patients with chronic obstructive pulmonary disease undergoing cardiac surgery.
Long-term steroid use is known to predispose surgery patients to infections of all types. As a result, physicians often hesitate to use steroids during the perioperative period, even when patients, such as those with chronic obstructive pulmonary disease (COPD), might benefit.
Dina Hanna, MD, a resident in the department of anesthesiology at the Cleveland Clinic Foundation in Ohio, United States, helps put those fears to rest with a study she presented at the annual meeting of the American Society of Anesthesiologists (ASA).
"We have always known that chronic steroid therapy increases the incidence of perioperative infection, but short-term perioperative steroid administration has not been studied," said Dr. Hanna.
Dr. Hanna and colleagues identified 732 patients with COPD who underwent cardiac surgery at the Cleveland Clinic between January 1998 and December 2000. The cohort was then divided into those who received steroids up to 15 days before surgery and 27 days after surgery (but not longer than 30 days overall), those who had been taking steroids long-term, and those who were not on steroids either prior to hospital admission or during their hospital stay.
Overall, 5.7 percent of patients experienced one or more infections. Infection rate was much higher among those on long-term steroids than either short-terms steroids or no steroids. There was no statistically significant difference between infection rates in those taking steroids short-term compared to those who were not taking them at all.
"These [results offer the] message not to hold back on short-term steroids or one or two doses of steroids in cardiac surgery for fear of infection," said Dr. Hanna.
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