Background/Purpose: Major and moderate surgeries are more common in patients with autoimmune diseases. However, there is limited data available regarding the use of standard doses of steroids versus stress doses in the perioperative period for moderate and major surgeries. However, stress dose steroids are still given perioperatively. Our study aims to evaluate the 30-day postoperative outcomes among patients with systemic lupus erythematous (SLE) and rheumatoid arthritis (RA) who received a perioperative stress dose vs therapeutic steroid dose and underwent moderate and major surgery.

Methods: We used observational data from TriNetX, an electronic database based in the United States. We identified patients with SLE and RA that underwent surgical procedures in the last 20 years. Moderate and major surgeries were defined according to the guidelines established by Liu et al., 2017 w. Treatment groups were defined as patients receiving a stress dose of steroids 3 days before moderate or major surgical procedure and patients receiving a therapeutic steroid dose during the same timeframe. Therapeutic dose was defined as 1-20mg of prednisone. The stress dose for moderate procedures was established as maintenance dose + 25–250 mg IV hydrocortisone. Major surgical procedure stress dose was established as maintenance + 50–250 mg IV hydrocortisone. Clinical variables included demographics, medical comorbidities, BMI, and . The following postoperative outcomes were measured: overall mortality, long-term ventilator requirement, and sepsis. All statistical analyses were completed using run 1:1 propensity score matching using logistic regression by TriNetX.

Results: A total of 3,231 patients were included. 837 patients were found to undergo major surgery after propensity-score matching (435 on each treatment group). A higher incidence of 30-day mortality was noted in patients who received a stress dose compared to those receiving the therapeutic dose (12.9% vs 4.1%, p< 0.001). Similar results were found when analyzing long-term ventilator requirement (23.2% vs 10.1%, p< 0.001) and sepsis (9% vs 4.8%, p=< 0.016). 

After propensity-score matching, a total of 594 patients that underwent moderate surgical intervention were included (297 patients on each treatment group). Interestingly, the moderate surgery group found no difference in mortality, ventilator dependence, and sepsis in the stress dose group compared to the therapeutic group, partially due to a lack of sample size (4% vs 3.4%, p >0.05)

Conclusion: There was a significant association with increased mortality, sepsis, and long-term ventilator requirements in patients receiving stress dose steroids vs therapeutic dose one-month inpatients with SLE and RA underwent major surgeries. There was no association with increased mortality, sepsis and long-term ventilator requirements in patients receiving stress dose steroids vs therapeutic dose one-month after in patients with SLE and RA who underwent moderate surgeries.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/perioperative-stress-dose-vs-therapeutic-dose-comparison-one-month-postoperative-outcomes-in-moderate-and-major-surgeries-for-systemic-lupus-erythematous-and-rheumatoid-arthritis/