From the Guidelines
Patients on chronic prednisone therapy should continue their usual dose on the day of surgery to prevent adrenal insufficiency, and stopping prednisone prior to laparoscopic procedures is not typically recommended. The decision about steroid management should be made in consultation with both the surgeon and the physician who prescribed the prednisone, as individual circumstances may vary. According to the 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline 1, patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty should continue their current daily dose of glucocorticoids, rather than administering perioperative supra-physiologic glucocorticoid doses.
Some key points to consider include:
- The risk of adrenal insufficiency due to surgical stress has been described in patients on chronic glucocorticoid therapy, and supplemental "stress-dose" steroids may be recommended for patients taking prednisone long-term (more than 3 weeks) or at high doses (more than 20 mg daily) 1.
- The British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults recommend that prior to elective surgery, corticosteroids should be stopped or dose minimised wherever possible to reduce risk of postoperative complications, but this may not apply to all patients on chronic prednisone therapy 1.
- Patients should inform their surgical team about all medications they are taking, including prednisone, during pre-operative assessment, and the decision about steroid management should be individualized based on the patient's specific circumstances.
In terms of specific recommendations, the 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline 1 suggests that patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty should continue their current daily dose of glucocorticoids, rather than administering perioperative supra-physiologic glucocorticoid doses. However, for patients taking prednisone long-term (more than 3 weeks) or at high doses (more than 20 mg daily), supplemental "stress-dose" steroids may be recommended, such as hydrocortisone 100 mg IV before anesthesia induction 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Stopping Prednisone Before Laparoscopic Procedure
- The decision to stop prednisone before a laparoscopic procedure depends on various factors, including the patient's medical history and the type of procedure being performed 2, 3.
- There is no clear consensus on when to stop prednisone before a laparoscopic procedure, as the evidence is limited and inconclusive 3, 4.
- Some studies suggest that patients with adrenal insufficiency may need to continue taking prednisone until the day of the procedure, while others recommend stopping it a few days before 2, 5.
- The risk of adrenal insufficiency and the need for supplemental steroids during the perioperative period should be carefully evaluated on a case-by-case basis 3, 4.
Factors to Consider
- The patient's medical history, including the presence of adrenal insufficiency or other conditions that may affect steroid use 4, 5.
- The type and duration of the laparoscopic procedure, as well as the anticipated level of stress and potential for complications 2, 3.
- The patient's current dose and duration of prednisone treatment, as well as their overall health status 4, 6.
Recommendations
- Patients with adrenal insufficiency should be carefully evaluated and monitored during the perioperative period to minimize the risk of adrenal crisis 3, 4.
- The use of supplemental steroids during the perioperative period should be considered on a case-by-case basis, taking into account the patient's individual needs and medical history 2, 3.
- Further research is needed to determine the optimal timing and dose of prednisone in patients undergoing laparoscopic procedures 3, 6.