EP132 - Differences in steroid use and colectomy outcomes of patients with Crohn's disease or ulcerative colitis

Purpose/Background: We wanted to assess whether preoperative corticosteroid use within 30 days of colectomy or ileocolic resection influences short-term postoperative outcomes in inflammatory bowel disease (IBD), while analyzing ulcerative colitis (UC) and Crohn's disease (CD) as separate cohorts.

Methods/Interventions: Adults aged 18-99 years who underwent colectomy for UC or CD were identified from the 2021-2023 ACS-NSQIP Targeted Colectomy database. Patients were stratified by preoperative corticosteroid exposure and analyzed by disease type. Propensity score matching was performed in a 1:1 ratio within each disease group, adjusting for age, hypertension, smoking status, and race. Postoperative outcomes within 30 days, including mortality, surgical site infection, anastomotic leak, reoperation, transfusion, venous thromboembolism (VTE), and unplanned readmission, were statistically compared.

Results/Outcomes: After matching, 541 UC patients and 2,150 CD patients who received preoperative corticosteroids were compared with equal numbers of matched controls who did not receive corticosteroids. In CD, corticosteroid use was not associated with increased mortality (steroid 0.5% vs. non-steroid 0.3%, p = 0.466), surgical site infection (3.4% vs. 2.7%, p = 0.186), anastomotic leak (2.8% vs. 2.4%, p = 0.387), reoperation (4.4% vs. 4.2%, p = 0.764), or VTE (1.1% vs. 1.0%, p = 0.767). Postoperative sepsis was slightly lower among corticosteroid users with CD (3.8% vs. 5.1%, p = 0.046), whereas unplanned readmission was higher (10.5% vs. 8.4%, p = 0.016). In UC, corticosteroid use was associated with higher rates of postoperative transfusion (16.8% vs. 11.3%, p = 0.0087) and pulmonary embolism (2.0% vs. 0.4%, p = 0.012), but lower rates of septic shock (5.9% vs. 10.5%, p = 0.0057). Within each disease group, no significant differences were observed between the steroid-use and non-use cohorts in mortality, surgical site infection, anastomotic leak, reoperation, or unplanned readmission.

Conclusion/Discussion: Preoperative corticosteroid use within 30 days of colectomy was not associated with increased major infectious or anastomotic complications in either UC or CD. However, these disease-specific secondary risks highlight the need for separate perioperative risk assessment in UC and CD. Careful perioperative management and ongoing attention to infection prevention and thromboembolism prophylaxis remain essential, and future prospective studies are warranted to clarify longer-term outcomes and the impact of steroid dose and duration on both UC and CD.