From the Guidelines
Patients on chronic steroid therapy should resume their regular dose within 24 hours after surgery, as abrupt discontinuation can lead to adrenal insufficiency 1. The decision to restart antirheumatic therapy, including corticosteroids, should be based on careful assessment of the patient’s wound status and clinical judgment for absence of surgical and non–surgical site infections 1. Some key points to consider when resuming corticosteroid therapy after surgery include:
- The patient's specific situation and underlying condition
- The type of surgery and overall health status
- The risk of postoperative complications, such as infection and anastomotic leaks, associated with high-dose steroid use 1
- The importance of adequate steroid levels for proper wound healing and managing physiological stress
- The need to balance providing sufficient coverage with minimizing side effects It is essential to consult with the surgeon and endocrinologist for personalized guidance, as they can provide tailored advice based on the individual's unique circumstances 1. Additionally, patients who received stress-dose steroids during surgery can typically taper back to their pre-surgical maintenance dose over 1-3 days as they recover 1. However, it is crucial to note that higher doses of steroids can potentially delay wound healing and increase infection risk, so the balance between providing sufficient coverage and minimizing side effects is critical 1. In general, the goal is to resume the patient's regular corticosteroid dose as soon as possible after surgery, while minimizing the risk of postoperative complications 1.
From the Research
Resuming Steroid Therapy After Surgery
The decision to resume steroid therapy after surgery depends on various factors, including the type of surgery, the patient's overall health, and the dosage of steroids being taken.
- The study 2 found that high preoperative steroid doses (> 80 mg/day) were associated with an increased risk of postoperative complications, suggesting that patients taking high doses of steroids may need to wait longer before resuming therapy.
- Another study 3 found that postoperative steroid use can be a safe and effective means to reduce pain and inflammation after foot surgery, but the optimal timing for resuming steroid therapy was not specified.
- A review of the literature 4 found that a single dose of dexamethasone probably does not increase the risk for postoperative infection, but the effects of dexamethasone on delayed wound healing are unclear.
- The use of corticosteroids in oral surgery 5 has been shown to reduce pain, edema, and trismus, but the potential for complications such as adrenal suppression and delayed wound healing must be considered.
- An animal study 6 found that high-dose steroid therapy started 2 days prior to surgery and continued until 5 and 7 days after surgery did not decrease the strength of colonic anastomoses, but dexamethasone slowed the rate of wound healing.
Factors to Consider
When deciding how soon to resume steroid therapy after surgery, the following factors should be considered:
- The type and dosage of steroids being taken
- The type of surgery and the patient's overall health
- The risk of postoperative complications, such as infection and delayed wound healing
- The potential benefits of steroid therapy, such as reduced pain and inflammation
Steroid Dosage and Timing
The optimal timing for resuming steroid therapy after surgery is not well established and may depend on the individual patient's circumstances.
- Patients taking high doses of steroids (> 80 mg/day) may need to wait longer before resuming therapy due to the increased risk of postoperative complications 2.
- A single dose of dexamethasone may be safe and effective for reducing pain and inflammation after surgery, but the effects on delayed wound healing are unclear 4.