• Erman Aytac, Jorge Mario Rosselli Londono, Hasan Hakan Erem, Jon D Vogel, and Meagan M Costedio.
• Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
• Dis. Colon Rectum. 2013 Nov 1; 56 (11): 1253-8.

BackgroundStress dose steroids are administered during the perioperative period to prevent complications of secondary hypoadrenalism, which can occur after long-term steroid treatment. Steroids also increase postoperative morbidity. Patients with ulcerative colitis often require steroid therapy before definitive surgery and often receive perioperative steroids in a variety of doses.ObjectiveThe aim of this study was to evaluate the impact of stress dose steroid administration on short-term postoperative outcomes after restorative proctocolectomy in patients with ulcerative colitis.DesignThis was a retrospective cohort study.SettingThe investigation took place in a high-volume, specialized colorectal surgery department.PatientsPatients who had been treated with steroids for ulcerative colitis and underwent a restorative proctocolectomy from January 2009 to July 2011 were identified and categorized into 2 groups based on whether they received stress dose steroids.Main Outcome MeasuresBoth cohorts were compared for patient demographics, duration of steroid treatment before surgery, and operative and postoperative outcomes.ResultsEighty-nine patients received stress dose steroids and 146 patients did not. Stress dose steroids were more frequently administered to patients who were under steroid treatment immediately before restorative proctocolectomy (37.1% versus 10.3%; p < 0.001). A sinus tachycardia developed more frequently in patients who received stress dose steroids during surgery (p = 0.03). One patient in the stress dose steroid group died on postoperative day 25 because of anastomotic leak. Although no patients in either group had an adrenal crisis during surgery, 1 patient in the stress dose steroid group was diagnosed with adrenal insufficiency postoperatively.LimitationsThis study was limited by its retrospective and nonrandomized nature.ConclusionsAlthough administration of stress dose steroids is not related to increased postoperative complications, the steroids do not appear to affect adrenal insufficiency outcomes. Patients who were treated with steroids for ulcerative colitis should be monitored carefully in the perioperative and early postoperative periods for signs of adrenal insufficiency, regardless of the steroid regimen used.

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