The reduced risk of septic shock/sepsis with laparoscopic surgery among ulcerative colitis patients with preoperative chronic steroid use

Surgery. 2021 Oct;170(4):1047-1053. doi: 10.1016/j.surg.2021.03.058. Epub 2021 Apr 28.


Background: Preoperative steroid use has been associated with worse surgical outcomes. The purpose of this study was to determine whether laparoscopic surgery reduces the risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use.

Methods: Patients with ulcerative colitis undergoing a total abdominal colectomy were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2005-2019). Patients were stratified based on preoperative chronic steroid use and operative approach (open versus laparoscopic). The primary outcome was septic shock/sepsis. Multivariable regression models were used to assess the association between laparoscopic surgery and rates of septic shock/sepsis among steroid users and non-steroid users in both the elective and emergent settings.

Results: Among 8,644 patients undergoing a total abdominal colectomy, 67.1% were steroid users and 32.9% were non-steroid users. Compared with an open approach, elective laparoscopic surgery was associated with lower rates of septic shock/sepsis, albeit with higher readmission rates for both steroid users (15.1% [laparoscopic] vs 12.0% [open], P = .005) and non-steroid users (12.6% [laparoscopic] vs 9.4% [open], P = .019). On adjusted analysis, ulcerative colitis patients with chronic steroid use undergoing an elective laparoscopic total abdominal colectomy demonstrated a reduced risk of septic shock/sepsis compared to open surgery (odds ratio 0.61, 95% confidence interval 0.49-0.76, P < .001). Similar findings were seen among chronic steroid users undergoing emergent laparoscopic procedures (odds ratio 0.54, 95% confidence interval 0.31-0.95, P = .031).

Conclusion: Laparoscopic surgery was associated with a reduced risk of septic shock/sepsis among ulcerative colitis patients with preoperative chronic steroid use, suggesting that minimally invasive surgery may be a promising option among this unique patient population.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Cohort Studies
  • Colectomy / adverse effects*
  • Colectomy / methods
  • Colitis, Ulcerative / surgery*
  • Drug Administration Schedule
  • Elective Surgical Procedures / adverse effects
  • Elective Surgical Procedures / methods
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Incidence
  • Laparoscopy / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Preoperative Care / methods*
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Shock, Septic / epidemiology
  • Shock, Septic / etiology
  • Shock, Septic / prevention & control*
  • Survival Rate / trends
  • United States / epidemiology


  • Glucocorticoids