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

[BACKGROUND] Chronic steroid use suppresses inflammation, edema, and autoimmunity, and delays wound healing. Using data from the American College of Surgeons National Surgical Quality Improvement Program, this study characterizes 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 American College of Surgeons National Surgical Quality Improvement Program database for the years 2006 to 2015. CPT codes were used to categorize operations. Patients were separated into two cohorts based on chronic steroid use status. Univariate analysis was performed using chi-square, Fisher's exact, or Wilcoxon rank sum test. Logistic regression models were fitted to evaluate the association between chronic steroid use and postoperative complications. Total hospital length of stay was compared. Odds ratios were computed at the 95 percent 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 with nonusers. Among the 10 most frequent procedures performed on chronic steroid users, steroid use was a significant risk factor for postoperative complications after reduction mammaplasty (OR, 2.2; p = 0.001); delayed insertion of breast prosthesis following mastopexy or mastectomy or during reconstruction (OR, 2.2; p = 0.049); and in trunk muscle, myocutaneous, or fasciocutaneous flap surgery (OR, 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.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, III.