Prevalence and outcomes of patients taking oral corticosteroids for over 1 month undergoing major surgery in England 2010-2020

Introduction: Approximately 1% of the UK population is prescribed oral corticosteroids at any one time. It is not known how many of these patients present for major surgery. We aimed to establish the prevalence, characteristics and outcomes of patients taking oral corticosteroids.

Methods: We identified patients aged > 18 y undergoing major surgery between 1 April 2010 and 31 March 2020 from Hospital Episode Statistics with linked Clinical Practice Research Datalink data and the Office for National Statistics Mortality register in England. Prescribing data were used to define three sets of patients: 'low-dose' - taking ≤ 7.5 mg oral prednisolone equivalents per day for at least 28/91 days before surgery; 'high-dose' - taking > 7.5 mg oral prednisolone equivalents per day for at least 28/ 91 days before surgery; and a 'no-steroids' group. We used ≤ 7.5 mg of prednisolone equivalents per day as our threshold, as this would likely exclude almost all patients who were taking corticosteroids as replacement for absolute adrenal/pituitary deficiency.

Results: We identified 1,999,326 adult patients for inclusion in the dataset: 1,929,291 (96.5%) in the no-steroids; 63,353 (3.2%) in the low-dose group; and 6682 (0.3%) in the high-dose group. Median (IQR [range]) duration of hospital stay increased with increasing dose of corticosteroid (no-steroid 3 (0-14 [0-14,739]); low-dose 5 (1-26 [1-8079]); and high-dose 7 (2-28 [0-6956]) days). Mortality after the index surgery was 1.5%, 3.8% and 8.9% at 30 days and 5.5%, 11.6% and 39.9% at 1 year for no-steroids, low-dose and high-dose groups, respectively.

Conclusion: Around 1 in 29 patients undergoing major surgery are taking oral corticosteroids for > 28 days in the 3 months before major surgery. Their outcomes are poor and warrant highlighting within care pathways to aid risk prediction and mitigation.