• Karen N Zaghiyan, Zuri Murrell, Gil Y Melmed, and Phillip R Fleshner.
• Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
• Am. J. Surg. 2012 Oct 1;204(4):481-6.

BackgroundSteroid-treated patients undergoing major colorectal surgery are routinely treated with high-dose steroids (HDS) to prevent perioperative adrenal insufficiency and cardiovascular collapse. However, there is no evidence to support this practice.MethodsA retrospective analysis of 97 consecutive steroid-treated patients with inflammatory bowel disease who underwent major colorectal surgery was performed. The incidence of hemodynamic instability and surgical outcomes were compared in patients treated with perioperative low-dose steroids (LDS) versus HDS.ResultsForty-three patients were treated with HDS, and 54 patients received LDS. There was no significant difference in hemodynamic instability between HDS-treated (74%) and LDS-treated (78%) patients. No patients required rescue HDS for adrenal insufficiency.ConclusionsSteroid-treated patients with inflammatory bowel disease undergoing major colorectal surgery appear to have no clinically significant hemodynamic instability when managed with LDS versus HDS. A prospective study assessing perioperative steroid dosing in patients with inflammatory bowel disease is in progress.Published by Elsevier Inc.

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