The effect of preventive use of corticosteroids on postoperative complications after esophagectomy: A retrospective cohort study

Abstract

Corticosteroids have been empirically administered to reduce the rate of acute respiratory distress syndrome (ARDS) after esophagectomy. However, their efficacy remains controversial, and corticosteroids may increase the risk of graft dehiscence and infection, which are major concerns after esophagectomy. Therefore, we compared the incidence of composite complications (ARDS, graft dehiscence and infection) after esophagectomy between patients who received a preventive administration of corticosteroids and those who did not. All patients who underwent esophagectomy from 2010 to 2015 at a tertiary care university hospital were reviewed retrospectively ( n = 980). Patients were divided into Steroid ( n = 120) and Control ( n = 860) groups based on the preventive administration of 100 mg hydrocortisone during surgery. The primary endpoint was the incidence of composite complications. The incidence of composite complications was not different between the Control and Steroid groups (17.4% vs. 21.7% respectively; P = 0.26). The incidence rates of complications in each category were not different between the Control and Steroid groups: ARDS (3.8% vs. 5.0%; P = 0.46), graft dehiscence (4.8% vs. 6.7%; P = 0.37), and infection (12.8% vs. 15.8%; P = 0.36). Propensity score matching revealed that composite complications (20.0% vs. 21.7%; P = 0.75), ARDS (4.3% vs. 5.2%; P = 0.76) and infection (16.5% vs. 15.7%; P = 0.86) were not different between the Control and Steroid group, but the incidence of graft dehiscence was higher in the Steroid group than in the Control group (0.9% vs. 7.0%; P = 0.0175). In conclusions, the preventive use of corticosteroids did not reduce the incidence of ARDS, but may be related to an increased incidence of graft dehiscence. Therefore, routine administration of corticosteroids to prevent ARDS is not recommended in esophagectomy.

Restrictive intraoperative fluid management was associated with higher incidence of composite complications compared to less restrictive strategies in open thoracotomy: A retrospective cohort study

“…Other information was collected from the patients' electronic medical records; For preoperative data, age, gender, comorbidities, American Society of Anesthesiologists (ASA) physical status, smoking status, alcohol consumption, clinical tumor, node, metastasis (TNM) stage, neoadjuvant chemoradiotherapy were collected 37 . Comorbid conditions included hypertension, diabetes mellitus, chronic renal disease (estimated glomerular filtration rate [eGFR] of <60 ml.min −1 .1.73 m 2-1 ), cerebrovascular disease, cardiac disease, and pulmonary dysfunction.…”

“…Comorbid conditions included hypertension, diabetes mellitus, chronic renal disease (estimated glomerular filtration rate [eGFR] of <60 ml.min −1 .1.73 m 2-1 ), cerebrovascular disease, cardiac disease, and pulmonary dysfunction. Cerebrovascular diseases (history thereof) included cerebral infarction, cerebral hemorrhage, and dementia/ Parkinson's disease/Alzheimer's disease 37 . Cardiac diseases included coronary artery disease and heart failure.…”

“…Pulmonary dysfunction included lung disease (chronic obstructive pulmonary disease, bronchiectasis, asthma, www.nature.com/scientificreports www.nature.com/scientificreports/ interstitial lung disease) and preoperative forced expiratory volume in one second (FEV 1 ) < 60% of predicted value. Current smokers were defined as patients who were still smoking or had stopped within 1 month before surgery 37 . Heavy drinking was defined as consuming 15 drinks or more per week for men and 8 drinks or more per week for women according to the Centers for Disease Control and Prevention (https://www.cdc.gov/alcohol/ fact-sheets/alcohol-use.htm).…”

“…For operative data, duration and type of surgery, intraoperative administration of an inotrope (dopamine or dobutamine continuous infusion) or vasopressor (phenylephrine or norepinephrine continuous infusion), method of postoperative analgesia were collected. For postoperative data, 24-hour postoperative input-output data, weight change after operation, postoperative complications up to discharge, in-hospital mortality, postoperative ICU stay, and days of hospitalization were collected 37 .…”

“…In cases of intraoperative bleeding, 5% human albumin (Green Cross, Gyeonggi, Korea) or 6% hydroxyethyl starch in balanced solution (Volulyte, Fresenius Kabi, Seoul, Korea) was given to the patient. Transfusion was performed for effective resuscitation if the transfusion cutoff (hemoglobin <8 g/dl) was reached 37 . Postoperative fluid management was standardized at 1-2 ml.kg −1 .h −1 .…”