Impact of Preoperative Chronic Steroid Use on Postoperative Outcomes following Open Surgical Repair of Unruptured Abdominal Aortic Aneurysm.

Introduction: Chronic corticosteroid use is associated with impaired wound healing and increased postoperative complications, but its impact on open surgical repair (OSR) of unruptured abdominal aortic aneurysms (AAA) remains unclear. Given the physiologic stress of OSR, identifying risk factors is essential. We aimed to evaluate the association between chronic steroid use and 30-day postoperative outcomes following elective OSR of unruptured AAA.

Methods: This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program from 2011-2023. Patients undergoing OSR of unruptured AAA were identified and stratified by chronic steroid use. Thirty-day postoperative outcomes were compared between groups. Univariate and multivariate logistic regression models evaluated the association between chronic steroid use and postoperative complications.

Results: 5,166 patients were included, with 143 (2.8%) on chronic steroids. After adjusting for preoperative and intraoperative factors, chronic steroid use was independently associated with increased risk of any surgical site infection (SSI) (aOR 2.02), deep incisional SSI (aOR 4.91), pneumonia (aOR 1.70), pulmonary embolism (aOR 5.18), transfusion requirement (aOR 1.61), systemic infection (aOR 2.24), sepsis (aOR 3.02), ischemic colitis (aOR 2.12), and bleeding from the prior AAA site (aOR 5.00) (all p < 0.05). Steroid use was linked to longer hospital stay (β=1.31 days) and ICU length of stay (β=0.94 days) (p < 0.05).

Conclusion: Chronic steroid use is associated with increased risk of postoperative complications following OSR of unruptured AAA. These findings suggest that chronic steroid use should be considered during patient selection and perioperative management to optimize outcomes.