Abstract：
OBJECTIVE: While existing literature reports adverse effects of chronic steroid use on surgical wound outcomes, there remains lack of data exploring the effect of steroids on postoperative outcomes following lower extremity arterial bypass surgery. This study aims to explore the effect of chronic steroid use on surgical outcomes in patients undergoing open revascularization for lower extremity arterial occlusive disease.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) files between 2005 and 2020, all patients receiving aortoiliac or infrainguinal arterial bypass for peripheral arterial disease (PAD) were identified by Current Procedural Terminology (CPT) codes. Patient characteristics and 30-day outcomes were compared using χ2 test and independent t-test, and association of chronic steroid use with wound complications was studied using multivariable logistic regression analysis.
RESULTS: A total of 44,675 patients undergoing open lower extremity revascularization were identified, of which 1,807 patients were on chronic steroids and 42,868 patients were not on chronic steroids. On multivariable logistic regression analysis, being on chronic steroids was associated with higher rates of deep SSI (OR 1.37, 95% CI 1.03-1.83), any SSI (OR 1.22, 95% CI 1.04-1.43) and wound dehiscence (OR 1.42, 95% CI 1.03-1.96). Chronic steroid users also had significantly increased odds of developing sepsis (OR 1.56, 95% CI 1.19-2.04), pneumonia (OR 1.44, 95% CI 1.08-1.91), UTI (OR 1.54, 95% CI 11.13-2.09), DVT (OR 1.60, 95% CI 1.01-2.53), and 30-day readmission (OR 1.30, 95% CI 1.12-1.50), reoperation (OR 1.17, 95% CI 1.01-1.37) and mortality (OR 1.33, 95% CI 1.01-1.76) compared to non-chronic steroid users.
CONCLUSIONS: This study confirms that chronic corticosteroid use is associated with higher risk of surgical site infections (SSIs) in patients undergoing lower extremity arterial bypass surgery. These patients typically have various underlying health issues, emphasizing the need for personalized treatment and management to reduce steroid-related postoperative complications and improve survival.
METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) files between 2005 and 2020, all patients receiving aortoiliac or infrainguinal arterial bypass for peripheral arterial disease (PAD) were identified by Current Procedural Terminology (CPT) codes. Patient characteristics and 30-day outcomes were compared using χ2 test and independent t-test, and association of chronic steroid use with wound complications was studied using multivariable logistic regression analysis.
RESULTS: A total of 44,675 patients undergoing open lower extremity revascularization were identified, of which 1,807 patients were on chronic steroids and 42,868 patients were not on chronic steroids. On multivariable logistic regression analysis, being on chronic steroids was associated with higher rates of deep SSI (OR 1.37, 95% CI 1.03-1.83), any SSI (OR 1.22, 95% CI 1.04-1.43) and wound dehiscence (OR 1.42, 95% CI 1.03-1.96). Chronic steroid users also had significantly increased odds of developing sepsis (OR 1.56, 95% CI 1.19-2.04), pneumonia (OR 1.44, 95% CI 1.08-1.91), UTI (OR 1.54, 95% CI 11.13-2.09), DVT (OR 1.60, 95% CI 1.01-2.53), and 30-day readmission (OR 1.30, 95% CI 1.12-1.50), reoperation (OR 1.17, 95% CI 1.01-1.37) and mortality (OR 1.33, 95% CI 1.01-1.76) compared to non-chronic steroid users.
CONCLUSIONS: This study confirms that chronic corticosteroid use is associated with higher risk of surgical site infections (SSIs) in patients undergoing lower extremity arterial bypass surgery. These patients typically have various underlying health issues, emphasizing the need for personalized treatment and management to reduce steroid-related postoperative complications and improve survival.
摘要：
目的：虽然现有文献报道了长期使用类固醇对手术伤口结局的不利影响，目前仍缺乏研究类固醇对下肢动脉搭桥手术后结局影响的数据.本研究旨在探讨长期使用类固醇对下肢动脉闭塞性疾病开放血运重建患者手术效果的影响。
方法：使用2005年至2020年之间的美国外科医生协会国家外科质量改进计划（ACS-NSQIP）文件，所有接受主动脉或腹股沟下动脉旁路术治疗外周动脉疾病（PAD）的患者均通过当前程序术语（CPT）代码进行鉴定。使用χ2检验和独立t检验比较患者特征和30天结局，使用多变量逻辑回归分析研究了长期使用类固醇与伤口并发症的关系。
结果：共有44,675例患者接受开放下肢血管重建术，其中1,807例患者使用慢性类固醇，42,868例患者未使用慢性类固醇。在多变量逻辑回归分析中，长期使用类固醇与较高的深部SSI发生率相关（OR1.37，95％CI1.03-1.83），任何SSI(OR1.22,95%CI1.04-1.43)和伤口裂开(OR1.42,95%CI1.03-1.96)。慢性类固醇使用者患败血症的几率也显著增加(OR1.56,95%CI1.19-2.04),肺炎（OR1.44，95%CI1.08-1.91），UTI（OR1.54，95%CI11.13-2.09），DVT（OR1.60，95%CI1.01-2.53），和30天再入院(OR1.30，95%CI1.12-1.50)，与非慢性类固醇使用者相比，再次手术（OR1.17，95％CI1.01-1.37）和死亡率（OR1.33，95％CI1.01-1.76）。
结论：这项研究证实，长期使用皮质类固醇与下肢动脉搭桥手术患者的手术部位感染（SSIs）风险较高有关。这些患者通常有各种潜在的健康问题，强调需要个性化的治疗和管理，以减少与类固醇相关的术后并发症并提高生存率。
方法：使用2005年至2020年之间的美国外科医生协会国家外科质量改进计划（ACS-NSQIP）文件，所有接受主动脉或腹股沟下动脉旁路术治疗外周动脉疾病（PAD）的患者均通过当前程序术语（CPT）代码进行鉴定。使用χ2检验和独立t检验比较患者特征和30天结局，使用多变量逻辑回归分析研究了长期使用类固醇与伤口并发症的关系。
结果：共有44,675例患者接受开放下肢血管重建术，其中1,807例患者使用慢性类固醇，42,868例患者未使用慢性类固醇。在多变量逻辑回归分析中，长期使用类固醇与较高的深部SSI发生率相关（OR1.37，95％CI1.03-1.83），任何SSI(OR1.22,95%CI1.04-1.43)和伤口裂开(OR1.42,95%CI1.03-1.96)。慢性类固醇使用者患败血症的几率也显著增加(OR1.56,95%CI1.19-2.04),肺炎（OR1.44，95%CI1.08-1.91），UTI（OR1.54，95%CI11.13-2.09），DVT（OR1.60，95%CI1.01-2.53），和30天再入院(OR1.30，95%CI1.12-1.50)，与非慢性类固醇使用者相比，再次手术（OR1.17，95％CI1.01-1.37）和死亡率（OR1.33，95％CI1.01-1.76）。
结论：这项研究证实，长期使用皮质类固醇与下肢动脉搭桥手术患者的手术部位感染（SSIs）风险较高有关。这些患者通常有各种潜在的健康问题，强调需要个性化的治疗和管理，以减少与类固醇相关的术后并发症并提高生存率。
