Preoperative steroid use linked to higher risk for complications following craniotomy

Key takeaways:

• Chronic steroid therapy before craniotomy for tumor resection was associated with postoperative complications and mortality.
• Researchers recommend “judicious” use of steroids in terms of duration and dosage.

Steroid use for at least 10 days before surgery was significantly associated with infectious and noninfectious complications, hospital readmissions and mortality in patients undergoing craniotomy for brain tumors, according to research.

“In patients undergoing craniotomy for tumor resection, steroids are often used to alleviate peritumor edema and mass effect preoperatively, allowing improvements in associated symptoms such as headache, seizures and even neurological deficits,” Usama Waqar, MBBS, of the Medical College at Aga Khan University in Pakistan, and colleagues wrote in Brain and Spine.

Waqar and fellow researchers aimed to examine the effects of steroid therapy on postoperative outcomes following craniotomy for tumor resection and identify risk factors of postoperative morbidity and mortality.

Their retrospective cohort study included data drawn from the American College of Surgeons National Surgical Quality Improvement Program of 27,037 adults (54% women; 87.3% white) who underwent supratentorial or infratentorial craniotomy between 2011 and 2019. Researchers compared perioperative characteristics and complications in patients with and without chronic steroid therapy, defined as steroid use for at least 10 days, and performed subgroup analyses on participants with chronic steroid therapy.

Patient comorbidities included smoking, physical and functional health status, diabetes mellitus, anemia, and pulmonary, cardiovascular and renal diseases. In addition to accounting for sociodemographic characteristics such as age, gender and race, researchers also classified participants according to BMI — healthy, underweight, overweight and obese.

Results showed that 4,386 individuals (16.2%) were on chronic steroid therapy, with univariate analyses demonstrating a higher incidence of postoperative complications, including infections, cardiac arrest and pulmonary and thromboembolic events, in this group compared with the non-steroid group (17.1% vs. 12). Longer length of hospital stay and mortality were also higher in the steroid group.

Chronic steroid use also was associated with any postoperative complication (OR = 1.481, 95% CI: 1.33-1.649) and infectious complication (OR = 1.522, 95% CI: 1.308-1.77), according to adjusted analysis.

Subgroup analysis identified risk factors for postoperative morbidity and mortality, which included older age, higher American Society of Anesthesiology physical status, pulmonary and cardiovascular comorbidities, anemia, prolonged operative time, disseminated cancer and meningioma.

“Preoperative brain tumor patients on steroids for 10 or more days are at a relatively high risk of postoperative complications,” Waqar and colleagues wrote. “We recommend a judicious use of steroids in brain tumor patients undergoing craniotomy, both in terms of dosage and duration of treatment.”

They added: “Given the associated risks, the need to reduce or even discontinue steroids as early before surgery as medically possible seems appropriate.”