SummaryIntroductionApproximately 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.MethodsWe 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.ResultsWe 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.ConclusionAround 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.

中文翻译：

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2010-2020 年英格兰接受大手术口服皮质类固醇超过 1 个月的患者的患病率和结果


摘要简介在任何时间，大约 1% 的英国人口被开具口服皮质类固醇。目前尚不清楚这些患者中有多少人接受了大手术。我们旨在确定服用口服皮质类固醇的患者的患病率、特征和结局。方法我们从 2010 年 4 月 1 日至 2020 年 3 月 31 日期间接受大手术的 > 患者从医院发作统计中确定了 2010 年 4 月 1 日至 2020 年 3 月 31 日期间接受大手术的患者，这些数据链数据链数据和英格兰国家统计局死亡率登记处。处方数据用于定义三组患者：“低剂量”——手术前至少 28/91 天每天服用 ≤ 7.5 mg 口服泼尼松龙当量;“高剂量” – 手术前至少 28/91 天每天服用 > 7.5 mg 口服泼尼松龙当量;以及一个“无类固醇”组。我们使用每天 ≤ 7.5 mg 泼尼松龙当量作为阈值，因为这可能会排除几乎所有服用皮质类固醇替代肾上腺/垂体绝对缺乏症的患者。结果我们确定了 1,999,326 名成年患者纳入数据集： 1,929,291 名 （96.5%） 接受非类固醇治疗;低剂量组 63,353 例 （3.2%）;高剂量组为 6682 例 （0.3%）。中位 （IQR [范围]）住院时间随着皮质类固醇剂量的增加而增加（无类固醇 3 （0-14 [0-14,739]）;低剂量 5 （1-26 [1-8079]）;和高剂量 7 （2-28 [0-6956]） 天）。无类固醇组、低剂量组和高剂量组 30 天指数手术后死亡率分别为 1.5% 、 3.8% 和 8.9%，1 年死亡率分别为 5.5% 、 11.6% 和 39.9%。结论每 29 例接受大手术的患者中约有 1 例在大手术前 3 个月内 28 d 服用口服皮质类固醇 >。 它们的结果很差，需要在护理途径中强调以帮助预测和缓解风险。