“Impact of Chronic Steroid Use on Plastic Surgery Outcomes: Analysis of 94,140 Cases”

Background: Steroids, commonly used to treat many chronic conditions, have been proven to suppress inflammation, edema, autoimmunity, and delay wound healing. Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), this study aims to characterize the risk of perioperative chronic steroid use for complications in plastic surgery cases. Methods: A retrospective study was performed on 94,140 plastic surgery cases from the ACS NSQIP database for the years 2006-2015. Current procedural terminology codes were used to categorize the operations. Patients were separated into two cohorts based on chronic steroid use status. Univariate analysis was performed using χ2, Fisher's exact tests, or Wilcoxon rank sum tests. Logistic regression models were fitted to evaluate the association between chronic steroid use and postoperative complications. Total hospital length of stay was compared for cohorts. Odds ratios were computed at the 95% confidence interval. Results: Chronic steroid users were more likely to develop surgical complications (OR 1.3; p=0.0452) and medical complications (OR 1.8; p=0.0002) compared to non-steroid users. Among the ten most frequent procedures performed on chronic steroid users, steroid use was a significant risk factor for postoperative complications after reduction mammoplasty (OR 2.2; p=0.001); delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction (OR 2.2; p=0.049); and in trunk muscle, myocutaneous or fasciocutaneus flap (7.2; p=0.0029). Conclusion: With this information in hand, plastic surgeons will be better equipped to counsel patients and adequately design perioperative protocols for chronic steroid users. Financial Disclosure: Nothing to disclose. Presented at: None applicable Acknowledgement: We would like to thank Dr. Ari Rubenfeld and Julie Moore for their assistance and guidance with access to the ACS NSQIP database and their guidance with this project. DISCLAIMER: American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Corresponding Author: Matthew J Ranzer, MD, Assistant Professor of Surgery, University of Illinois at Chicago, Division of Plastic, Reconstructive, and Cosmetic Surgery, 820 S Wood St, Suite 515 CSN, Chicago, IL 60612 USA. Office: 312-996-9313 Fax: 312-413-0495, E-mail: ranzerm@uic.edu ©2018American Society of Plastic Surgeons