Skip to main content

Advertisement

SpringerLink
Log in

Early Postoperative Outcomes of Primary Bariatric Surgery in Patients on Chronic Steroid or Immunosuppressive Therapy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Previous research suggests that patients on chronic steroids may be at an increased risk of postoperative morbidity after major surgery. We aimed to evaluate the prognostic impact of chronic use of steroid or immunosuppression on 30-day morbidity and mortality rates after primary bariatric surgery.

Methods

From American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified patients who underwent primary bariatric surgery between 2005 and 2013. Logistic regression was used to determine the prognostic impact of chronic use of steroid or immunosuppression on the 30-day postoperative outcomes.

Results

One thousand two hundred seventy seven steroid/immunosuppressant-dependent (SD) and 112,892 non-dependent (ND) patients were analyzed. SD patients had a higher baseline risk profile compared to ND patients. Thirty-day mortality rates for SD and ND patients were 0.55 and 0.11 %, respectively (P < 0.001) which corresponds to an adjusted odds ration (OR) of 6.85 (95 % confidence interval (CI) 1.95–24.12). SD patients had a higher 30-day major morbidity compared to ND patients (5.01 versus 2.54 %; P < 0.001, respectively). After adjustment, this translated into an OR of 2.21 (95 % CI 1.29–3.79). Among SD patients, there was no significant difference in 30-day major morbidity after gastric bypass compared to sleeve gastrectomy (OR = 0.36; 95 % CI 0.08–1.66).

Conclusions

Chronic and active use of steroid or immunosuppressant medications is a strong predictor of 30-day postoperative morbidity and mortality following primary bariatric surgery. Among the steroid/immunosuppressant users, complication rates were similar for gastric bypass and sleeve gastrectomy patients. Further studies are needed to help guide the management or discontinuation of such medications in the perioperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Makinodan T, Santos GW, Quinn RP. Immunosuppressive drugs. Pharmacol Rev. 1970;22(2):189–247.

    CAS  PubMed  Google Scholar 

  2. Barnes PJ, Adcock I. Anti-inflammatory actions of steroids: molecular mechanisms. Trends Pharmacol Sci. 1993;14(12):436–41.

    Article  CAS  PubMed  Google Scholar 

  3. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711–23.

    Article  CAS  PubMed  Google Scholar 

  4. Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, et al. Pre-admission use of glucocorticoids and 30-day mortality following colorectal cancer surgery: a population-based Danish cohort study. Aliment Pharmacol Ther. 2014;39(8):843–53.

    Article  CAS  PubMed  Google Scholar 

  5. Busti AJ, Hooper JS, Amaya CJ, et al. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25(11):1566–91.

    Article  CAS  PubMed  Google Scholar 

  6. Wang AS, Armstrong EJ, Armstrong AW. Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg. 2013;206(3):410–7.

    Article  CAS  PubMed  Google Scholar 

  7. Davis B, Rivadeneira DE. Complications of colorectal anastomoses: leaks, strictures, and bleeding. Surg Clin North Am. 2013;93(1):61–87.

    Article  PubMed  Google Scholar 

  8. Ismael H, Horst M, Farooq M, et al. Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg. 2011;201(3):305–8. discussion 8-9.

    Article  CAS  PubMed  Google Scholar 

  9. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  10. Brethauer SA, Aminian A, Romero-Talamas H, et al. Can diabetes be surgically cured? Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes mellitus. Ann Surg. 2013;258(4):628–36. discussion 36-7.

    PubMed  PubMed Central  Google Scholar 

  11. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.

    Article  PubMed  Google Scholar 

  12. Curran SP, Famure O, Li Y, et al. Increased recipient body mass index is associated with acute rejection and other adverse outcomes after kidney transplantation. Transplantation. 2014;97(1):64–70.

    Article  PubMed  Google Scholar 

  13. Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87(8):1167–73.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gagne DJ, Papasavas PK, Dovec EA, et al. Effect of immunosuppression on patients undergoing bariatric surgery. Surg Obes Relat Dis. 2009;5(3):339–45.

    Article  PubMed  Google Scholar 

  15. Gribsholt SB, Svensson E, Thomsen RW, et al. Preoperative glucocorticoid use and risk of postoperative bleeding and infection after gastric bypass surgery for the treatment of obesity. Surg Obes Relat Dis. 2015;15(pii: S1550–7289):00022–2.

    Google Scholar 

  16. Aminian A, Brethauer SA, Sharafkhah M, et al. Development of a sleeve gastrectomy risk calculator. Surg Obes Relat Dis. 2015;11(4):758–64.

    Article  PubMed  Google Scholar 

  17. American College of Surgeons. User Guide for the 2013 ACS NSQIP Participant Use Data File (PUF). Available at: http://site.acsnsqip.org/wp-content/uploads/2014/11/ACS_NSQIP_PUF_User_Guide_2013.pdf. Accessed 23 June, 2015.

  18. Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129(1):125–37.

    CAS  PubMed  Google Scholar 

  19. Nguyen GC, Elnahas A, Jackson TD. The impact of preoperative steroid use on short-term outcomes following surgery for inflammatory bowel disease. J Crohns Colitis. 2014;8(12):1661–7.

    Article  PubMed  Google Scholar 

  20. Gangireddy C, Rectenwald JR, Upchurch GR, et al. Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg. 2007;45(2):335–41. discussion 41-2.

    Article  PubMed  Google Scholar 

  21. Jacobs JWG, Bijlsma JWJ. Glucocorticoid therapy. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Sergent JS, editors. Kelly’s textbook of rheumatology. 8th ed. W.B. Saunders Company: St. Louis, MO; 2008. p. 863.

    Google Scholar 

  22. Schacke H, Docke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(1):23–43.

    Article  CAS  PubMed  Google Scholar 

  23. Aminian A, Daigle CR, Romero-Talamas H, et al. Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis. 2014;10(4):576–82.

    Article  PubMed  Google Scholar 

  24. Aminian A, Brethauer SA, Kirwan JP, et al. How safe is metabolic/diabetes surgery? Diabetes Obes Metab. 2015;17(2):198–201.

    Article  CAS  PubMed  Google Scholar 

  25. Corcelles R, Daigle CR, Talamas HR, et al. Bariatric surgery outcomes in patients with systemic lupus erythematosus. Surg Obes Relat Dis. 2015;11(3):684–8.

    Article  PubMed  Google Scholar 

  26. Hedrick TL, Heckman JA, Smith RL, et al. Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg. 2007;205(3):432–8.

    Article  PubMed  Google Scholar 

  27. Yu EW, Bouxsein ML, Putman MS, et al. Two-year changes in bone density after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab. 2015;100(4):1452–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    Amin Andalib, Ali Aminian, Zhamak Khorgami, Mohammad H. Jamal, Toms Augustin, Philip R. Schauer & Stacy A. Brethauer

Authors
  1. Amin Andalib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali Aminian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhamak Khorgami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad H. Jamal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Toms Augustin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philip R. Schauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stacy A. Brethauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stacy A. Brethauer.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest to declare.

Disclaimer

Since this study was performed using de-identified nationwide data, informed consent was not obtained for the purposes of this research. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andalib, A., Aminian, A., Khorgami, Z. et al. Early Postoperative Outcomes of Primary Bariatric Surgery in Patients on Chronic Steroid or Immunosuppressive Therapy. OBES SURG 26, 1479–1486 (2016). https://doi.org/10.1007/s11695-015-1923-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1923-0

Keywords

Search

Navigation