Can I undergo surgery while taking 40 mg of prednisone (corticosteroid) daily?

From the Guidelines

Surgery while taking 40 mg of prednisone daily is possible but requires special precautions and coordination with your healthcare team. You should never stop taking prednisone abruptly before surgery as this could cause dangerous adrenal insufficiency. Instead, inform your surgeon and anesthesiologist about your prednisone use during pre-surgical consultations. They may recommend "stress-dose steroids" during the perioperative period to prevent adrenal crisis, as suggested by the 2021 guidelines on acute abdomen in the immunocompromised patient 1. Your surgical team will need to monitor you more carefully for potential complications associated with corticosteroid use, including delayed wound healing, increased infection risk, blood sugar fluctuations, and blood pressure instability. The surgeon might also take extra precautions with wound closure techniques. Additionally, your recovery may take longer than average due to the immunosuppressive effects of prednisone.

Some key considerations for patients on long-term corticosteroids undergoing surgery include:

• The risk of postoperative infectious complications and anastomotic leaks is increased, particularly for those taking high-dose steroids (40 mg prednisolone or more) 1.
• The use of more than ≥15 mg oral corticosteroid in UC patients within 30 days of IPAA surgery, or more than ≥20 mg in the setting of proctocolectomy, is associated with increased risk of complications 1.
• Patients who are on corticosteroids at the time of their IBD surgery should be given intravenous hydrocortisone in equivalent dosage until they can resume oral prednisolone 1.
• Perioperative steroid replacement therapy is recommended for patients having major abdominal surgery with recent history of chronic steroid use 1.
• There is little evidence to support the practice of "stress-dose steroids" over simple continuation of the preoperative steroid doses 1.

It is essential to weigh the risks and benefits of surgery in patients taking high-dose corticosteroids and to develop a personalized plan for perioperative management, taking into account the patient's overall health, the type of surgery, and the potential risks of corticosteroid use 1.

From the FDA Drug Label

The lowest possible dose of corticosteroids should be used to control the condition under treatment. Drug-induced secondary adrenocortical insufficiency may be minimized by gradual reduction of dosage This type of relative insufficiency may persist for up to 12 months after discontinuation of therapy following large doses for prolonged periods; therefore, in any situation of stress occurring during that period, hormone therapy should be reinstituted.

The FDA drug label does not directly answer whether you can undergo surgery while taking 40 mg of prednisone daily. However, it does mention that drug-induced secondary adrenocortical insufficiency may occur, especially after large doses for prolonged periods, and that hormone therapy should be reinstituted in situations of stress, such as surgery 2.

• It is recommended to consult a doctor to determine the best course of action.
• The doctor may need to adjust the dosage or administer additional hormone therapy to minimize the risk of complications during surgery.
• Caution should be exercised when considering surgery for patients taking corticosteroids, as they may be at increased risk of complications.

From the Research

Surgery and Prednisone Use

• The use of prednisone, a corticosteroid, can have significant implications for patients undergoing surgery 3, 4, 5, 6.
• Studies have shown that preoperative steroid use can increase the risk of postoperative complications, such as superficial and deep surgical site infections, organ/space infections, and dehiscence 3.
• Additionally, chronic steroid use has been associated with poor healing and worse long-term outcomes in patients undergoing orthopedic surgery, particularly in shoulder surgery 5.

Risks Associated with Prednisone Use

• Patients on chronic steroids are at a higher risk for major, minor, and infectious complications after surgery, including arthroscopic and open rotator cuff repair, shoulder stabilization, and associated procedures 5.
• The duration of steroid therapy and the daily dose of hydrocortisone or equivalent before operation can also impact the risk of steroid-related complications after surgery 6.
• However, some studies suggest that a single preoperative high dose of methylprednisolone may not be associated with a significant increase in the incidence of adverse effects, and may even reduce pulmonary complications in trauma patients 4.

Considerations for Surgery

• Patients on chronic steroids should be counseled about their increased risk for postoperative complications and both preoperative risk stratification and optimization should be employed to minimize perioperative risk 5.
• A convenient mathematical model has been proposed to allow a preoperative assessment of surgical risk, using steroid dose and duration of treatment 6.
• The use of postoperative steroids to reduce pain and inflammation is a common practice, but its safety and efficacy are still being debated, with some studies indicating that it can delay healing and increase the risk of postoperative infection 7.