Analysis of the impact of chronic corticosteroid use on free flap reconstruction

Abstract

Background Systemic corticosteroids negatively impact wound healing, potentially increasing postoperative wound complication rates. In this study, the authors utilize the American College of Surgeons (ACS) National Surgical Quality Improvement (NSQIP) database to investigate the impact of chronic steroid usage on postoperative complications following microvascular free tissue transfer procedures. Methods The ACS NSQIP database was queried for all free flap procedures performed between 2005 and 2016. Patients with a history of chronic steroid use (n = 159) were compared to patients with no history of chronic steroid use (n = 3,405). The two cohorts were compared by univariate analysis, followed by multivariate binary logistic regression for all complications noted to be statistically significant on univariate analysis. Results Patients treated with systemic corticosteroids were more likely to be smokers, have a history of diabetes, hypertension, bleeding disorders, hypoalbuminemia, anemia, and have a wound infection at time of surgery. There were increased rates of bleeding requiring transfusion (37.7 vs. 27.5% p = .005), overall surgical complications (48.4 vs. 36.7%, p = .003) and overall complication rates (56.0 vs. 42.3%, p = .001) in these patients. On multivariate analysis, chronic steroid use was not associated with increased risk of surgical complications (OR = 2.540, p = .056, 95% CI 0.975–6.622), overall complications (OR = 2.303, p = .086, 95% CI 0.888–5.973), or wound complications. However, chronic steroid usage conferred nearly a four times increased risk for major bleeding complications (OR = 3.995, p = .009, 95% CI 1.415–11.279). Conclusion Chronic corticosteroid use does not increase rates of wound complications, reoperation, or readmission. However, this population may be at increased risk for major bleeding requiring blood transfusion following free flap reconstruction.

Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study

“…The association between oral corticosteroid use and the risk of complications in TBLC has not been reported before. In a study of plastic surgery complications, long term corticosteroid use increased major bleeding complications [30]. Another study reported that intravenous corticosteroid administered on the day of the tonsillectomy increased the risk of a reoperation for hemostasis in children (≤15 years) but not in adults (>15 years) [31].…”

Microvascular free tissue transfer for reconstruction of complex lower extremity trauma: Predictors of complications and flap failure

“…Immunocompromised status in this study was found to be predictive of both failure and major complications. Previous research has indicated that patients in an immunocompromised state, such as chronic steroid use, are at risk for greater flap complications (Weisberger et al, 2019). Additionally, some immunosuppressive agents are associated with an increased risk of thrombotic formation (Sarkodee‐Adoo et al, 2003).…”

Unplanned reoperations after microsurgical breast reconstruction: Findings from the American College of Surgeons National Surgical Quality Improvement Program

“…We have further applied the same multivariate logistic regression model to different subset of reoperations and risk stratified based on preoperative variables. For example, preoperative steroid intake in patients undergoing free flaps has been reported to be a risk factor for major bleeding complications (Sbitany et al, 2014; Weisberger et al, 2021). However, we not only found preoperative steroid intake as an independent risk factor for unplanned reoperation but further stratified bleeding as one the indication of early reoperation.…”