Secondary Logo

Institutional members access full text with Ovid®

Impact of Chronic Steroid Use on Plastic Surgery Outcomes: Analysis of 94,140 Cases

Barcha, Carolina P., M.S.P.H.; Ranzer, Matthew J., M.D.

Plastic and Reconstructive Surgery: November 2018 - Volume 142 - Issue 5 - p 770e-779e
doi: 10.1097/PRS.0000000000004865
Plastic Surgery Focus: Special Topics
Buy
Patient Safety CME
Discussion

Background: Chronic steroid use suppresses inflammation, edema, and autoimmunity, and delays wound healing. Using data from the American College of Surgeons National Surgical Quality Improvement Program, this study characterizes the risk of perioperative chronic steroid use for complications in plastic surgery cases.

Methods: A retrospective study was performed on 94,140 plastic surgery cases from the American College of Surgeons National Surgical Quality Improvement Program database for the years 2006 to 2015. CPT codes were used to categorize operations. Patients were separated into two cohorts based on chronic steroid use status. Univariate analysis was performed using chi-square, Fisher’s exact, or Wilcoxon rank sum test. Logistic regression models were fitted to evaluate the association between chronic steroid use and postoperative complications. Total hospital length of stay was compared. Odds ratios were computed at the 95 percent confidence interval.

Results: Chronic steroid users were more likely to develop surgical complications (OR, 1.3; p = 0.0452) and medical complications (OR, 1.8; p = 0.0002) compared with nonusers. Among the 10 most frequent procedures performed on chronic steroid users, steroid use was a significant risk factor for postoperative complications after reduction mammaplasty (OR, 2.2; p = 0.001); delayed insertion of breast prosthesis following mastopexy or mastectomy or during reconstruction (OR, 2.2; p = 0.049); and in trunk muscle, myocutaneous, or fasciocutaneous flap surgery (OR, 7.2; p = 0.0029).

Conclusion: With this information in hand, plastic surgeons will be better equipped to counsel patients and adequately design perioperative protocols for chronic steroid users.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Patient Safety CME.

Chicago, Ill.

From the Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago.

Received for publication October 12, 2017; accepted April 25, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to PlasticSurgery.org Dashboard, clicking “Submit CME,” and completing the form.

Matthew J. Ranzer, M.D., Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago, 820 South Wood Street, Suite 515 CSN, Chicago, Ill. 60612, ranzerm@uic.edu

Copyright © 2018 by the American Society of Plastic Surgeons