围手术期补充外源性类固醇 (PREdS):对目前服用治疗性类固醇的患者围手术期处方的全国性审计

IF 7.5 1区 医学 Q1 ANESTHESIOLOGY
Anaesthesia Pub Date : 2024-08-03 DOI:10.1111/anae.16388
Oliver J. H. Barker, Aravind V. Ramesh, Inthu Kangesan, Jonathan Barnes, Suzanne Harrogate, Swati Gupta, Barnaby C. Reeves, Ben Gibbison, the PREdS Trainee Research Network Collaborators
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引用次数: 0

摘要

每年约有 1%的英国人口服皮质类固醇的时间超过 28 天,原因大致有两个:皮质类固醇缺乏,需要补充;或治疗炎症的皮质类固醇。在生理应激时(如手术),可能会出现急性皮质类固醇缺乏症,从而可能导致重大并发症。麻醉师协会的 2020 年共识指南为肾上腺功能不全患者围手术期的糖皮质激素管理提供了详细建议。此次全国性审计旨在评估该指南的遵守情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peri-operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids

Introduction

Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline.

Methods

Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed < 5 mg oral prednisolone equivalents.

Results

Operations for 21,731 patients were audited: 277 (1.3%) patients were taking therapeutic corticosteroids. Detailed peri-operative data were collected for all patients receiving therapeutic corticosteroids: 201/277 (73%) were ASA physical status ≥ 3; 184/277 (66%) underwent elective procedures; and 252/277 (91%) were prescribed prednisolone pre-operatively, of whom 219/277 (79%) were prescribed ≥ 5 mg oral prednisolone equivalents. In the patients who were prescribed ≥ 5 mg oral prednisolone equivalents, 186/219 (85%) received pre-operative glucocorticoid supplementation and 97/219 (42%) received it postoperatively; however, only 67/219 (31%) and 43/219 (20%) respectively received glucocorticoid supplementation according to the guidelines. Overall, peri-operative prescribing was compliant in 19/219 (9%) patients. A similar proportion, 30/219 (14%), received no supplementation. In the patients taking < 5 mg oral prednisolone equivalents pre-operatively, 28/58 (48%) received inappropriate supplementation.

Conclusions

Despite 125/277 (45%) of anaesthetists reporting Association of Anaesthetists' guidelines use, compliance remained low, with adherence in only 27/125 (22%) patients. Further research is required to identify the correct peri-operative strategy for patients taking therapeutic corticosteroids.

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来源期刊
Anaesthesia
Anaesthesia 医学-麻醉学
CiteScore
21.20
自引率
9.30%
发文量
300
审稿时长
6 months
期刊介绍: The official journal of the Association of Anaesthetists is Anaesthesia. It is a comprehensive international publication that covers a wide range of topics. The journal focuses on general and regional anaesthesia, as well as intensive care and pain therapy. It includes original articles that have undergone peer review, covering all aspects of these fields, including research on equipment.
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