Perioperative corticosteroid practices in otorhinolaryngologic surgery: decision-making, autonomy conflicts, and defensive attitudes among anesthesiologists in Turkey: a multicenter cross-sectional survey study.

Abstract

Objective: Despite strong evidence supporting the use of perioperative corticosteroids in otorhinolaryngologic (ENT) surgery, significant heterogeneity exists in clinical practice. This study aimed to evaluate the indications, agent/dosage preferences, autonomy in decision-making processes, and defensive medical attitudes regarding potential complications of corticosteroid use among anesthesiologists in Turkey.

Materials and methods: This multicenter, cross-sectional, web-based survey included 158 anesthesiologists working in various healthcare institutions. Participants' steroid prescribing habits, pharmacological preferences, interdisciplinary decision-making dynamics across eight different ENT procedures, and concerns regarding complications (bleeding, wound healing, hyperglycemia, infection) were investigated. Furthermore, clinical management approaches were evaluated using a scenario involving a well-controlled diabetic patient.

Results: The most frequently reported indication for corticosteroid use was the prevention of airway edema (90.5%), and the most preferred regimen was 1 mg/kg methylprednisolone (68.4%). The procedures with the highest rates of autonomous steroid administration by anesthesiologists without consulting the surgeon were adenotonsillectomy (73.4%) and microlaryngeal surgery (65.8%). Participants' concern scores for postoperative hyperglycemia were significantly higher than those for bleeding (mean 2.80 vs. 1.84; p < 0.001). In a scenario involving a well-regulated diabetic patient, only 42.4% of the physicians stated they would continue the standard dose with intensified blood glucose monitoring, whereas the remaining majority (57.6%) exhibited pronounced defensive approaches, such as reducing the dose, withholding it entirely, or reserving it exclusively for critical airway emergencies (46.2%).

Conclusion: Although corticosteroid practices among Turkish anesthesiologists in ENT surgery are generally consistent with current literature, defensive attitudes stemming from the fear of postoperative hyperglycemia lead to medically unjustified, suboptimal treatment approaches in diabetic patients. The uncertainties in interdisciplinary decision-making processes and the unnecessary reliance on surgical approval highlight a critical need for institutional, evidence-based perioperative management protocols developed collaboratively by anesthesiology and ENT specialty societies.