Expanded indications for bariatric surgery: should patients on chronic steroids be offered bariatric procedures?

Jennifer A. Kaplan, Samuel C. Schecter, Stanley J. Rogers, Matthew Y.C. Lin, Andrew M. Posselt, Jonathan T. Carter

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background Patients who take chronic corticosteroids are increasingly referred for bariatric surgery. Little is known about their clinical outcomes. Objective Determine whether chronic steroid use is associated with increased morbidity and mortality after stapled bariatric procedures. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods All patients who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass and were reported to the ACS-NSQIP from 2011 to 2013 were reviewed. Patients were grouped based on type of surgery and history of chronic steroid use. Primary outcome measures were mortality and serious morbidity in the first 30 days. Regression analyses were used to determine predictors of outcome. Results Of 23,798 patients who underwent laparoscopic sleeve gastrectomy and 38,184 who underwent Roux-en-Y gastric bypass, 385 (1.6%) and 430 (1.1%), respectively, were on chronic steroids. Patients on chronic steroids had a 3.4 times increased likelihood of dying within 30 days (95% confidence interval 1.4–8.1, P = .007), and 2-fold increased odds of serious complications (95% confidence interval 1.2–2.3, P = .008), regardless of surgery type. In multivariate regression, steroid usage remained an independent predictor of mortality and serious complications. Conclusion In a large, nationally representative patient database, steroid use independently predicted mortality and serious postoperative complications after stapled bariatric procedures. Surgeons should be cautious about offering stapled bariatric procedures to patients on chronic steroids.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalSurgery for Obesity and Related Diseases
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2017

Bibliographical note

Publisher Copyright:
© 2017 American Society for Bariatric Surgery

Keywords

  • Bariatric surgery
  • Morbidity
  • Mortality
  • Outcomes
  • Predictors
  • Steroids

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