• Jennifer A Kaplan, Samuel C Schecter, Stanley J Rogers, Lin Matthew Y C MYC Department of Surgery, University of California San Francisco, San Francisco, California., Andrew M Posselt, and Jonathan T Carter.
• Department of Surgery, University of California San Francisco, San Francisco, California. Electronic address: Jenny.Kaplan@ucsf.edu.
• Surg Obes Relat Dis. 2017 Jan 1; 13 (1): 35-40.

BackgroundPatients who take chronic corticosteroids are increasingly referred for bariatric surgery. Little is known about their clinical outcomes.ObjectiveDetermine whether chronic steroid use is associated with increased morbidity and mortality after stapled bariatric procedures.SettingAmerican College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.MethodsAll patients who underwent laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass and were reported to the ACS-NSQIP from 2011 to 2013 were reviewed. Patients were grouped based on type of surgery and history of chronic steroid use. Primary outcome measures were mortality and serious morbidity in the first 30 days. Regression analyses were used to determine predictors of outcome.ResultsOf 23,798 patients who underwent laparoscopic sleeve gastrectomy and 38,184 who underwent Roux-en-Y gastric bypass, 385 (1.6%) and 430 (1.1%), respectively, were on chronic steroids. Patients on chronic steroids had a 3.4 times increased likelihood of dying within 30 days (95% confidence interval 1.4-8.1, P = .007), and 2-fold increased odds of serious complications (95% confidence interval 1.2-2.3, P = .008), regardless of surgery type. In multivariate regression, steroid usage remained an independent predictor of mortality and serious complications.ConclusionIn a large, nationally representative patient database, steroid use independently predicted mortality and serious postoperative complications after stapled bariatric procedures. Surgeons should be cautious about offering stapled bariatric procedures to patients on chronic steroids.Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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