Chronic corticosteroid therapy impairs postoperative outcomes of pancreatic surgery: International multicenter retrospective study.

Authors

Riccardo Pellegrini, Aya Maekawa, Giampaolo Perri, Ilaria Govoni, Pietro Rigo, Salvador Rodriguez Franco, Atsushi Nara, Karla M Navarrete Galvez, Marcel den Dulk, Stefan A W Bouwense, Richard D Schulick, Umberto Cillo, Marco Del Chiaro, Giovanni Marchegiani

Published in

Surgery. Pages 110661. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

Patients receiving chronic corticosteroid therapy often have complex conditions and may face an increased risk of adverse postoperative outcomes. In pancreatic surgery, pancreas-specific and infectious complications significantly affect recovery, but evidence on the impact of chronic corticosteroid therapy remains limited.
This multicenter retrospective study included patients undergoing pancreatic resection between 2012 and 2025. Chronic corticosteroid therapy was defined as systemic corticosteroids at a prednisone-equivalent dose ≥5 mg/d for ≥4 consecutive weeks before surgery. Propensity score matching was performed within each center in a 1:3 ratio using age, sex, body mass index, Charlson Comorbidity Index, and type of pancreatic resection. The primary outcome was major morbidity, defined as Clavien-Dindo ≥IIIa.
Of 2,564 patients, 52 received chronic corticosteroid therapy. After matching, 49 patients receiving chronic corticosteroid therapy were compared with 147 patients not receiving chronic corticosteroid therapy. Chronic corticosteroid therapy was associated with worse postoperative outcomes, including major morbidity (59.2% vs 30.6%; P < .001), Comprehensive Complication Index (34.6 vs 20.9; P < .001), longer postoperative hospital stays (15 vs 10 days; P = .007), 30-day readmission (29.5% vs 15.8%; P = .049), and 90-day mortality (10.2% vs 2.0%; P = .025). Infectious complications were more frequent, especially deep incisional surgical site infection/organ-space infection, sepsis, and pneumonia (all P < .05). In matched conditional logistic regression, chronic corticosteroid therapy remained associated with major morbidity (odds ratio, 3.20; 95% confidence interval, 1.63-6.28) and infectious complications (odds ratio, 4.66; 95% confidence interval, 2.31-9.40).
Chronic corticosteroid therapy identifies a higher-risk subgroup undergoing pancreatic resection, supporting its inclusion in perioperative risk stratification and multidisciplinary planning.

PMID:
42977605
Bibliographic data and abstract were imported from PubMed on 04 Nov 2026.

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