Impact of stress dose steroids on the outcomes of restorative proctocolectomy in patients with ulcerative colitis.

BACKGROUND: Stress dose steroids are administered during the perioperative period to prevent complications of secondary hypoadrenalism, which can occur after long-term steroid treatment. Steroids also increase postoperative morbidity. Patients with ulcerative colitis often require steroid therapy before definitive surgery and often receive perioperative steroids in a variety of doses. OBJECTIVE: The aim of this study was to evaluate the impact of stress dose steroid administration on short-term postoperative outcomes after restorative proctocolectomy in patients with ulcerative colitis. DESIGN: This was a retrospective cohort study. SETTING: The investigation took place in a high-volume, specialized colorectal surgery department. PATIENTS: Patients who had been treated with steroids for ulcerative colitis and underwent a restorative proctocolectomy from January 2009 to July 2011 were identified and categorized into 2 groups based on whether they received stress dose steroids. MAIN OUTCOME MEASURES: Both cohorts were compared for patient demographics, duration of steroid treatment before surgery, and operative and postoperative outcomes. RESULTS: Eighty-nine patients received stress dose steroids and 146 patients did not. Stress dose steroids were more frequently administered to patients who were under steroid treatment immediately before restorative proctocolectomy (37.1% versus 10.3%; p < 0.001). A sinus tachycardia developed more frequently in patients who received stress dose steroids during surgery (p = 0.03). One patient in the stress dose steroid group died on postoperative day 25 because of anastomotic leak. Although no patients in either group had an adrenal crisis during surgery, 1 patient in the stress dose steroid group was diagnosed with adrenal insufficiency postoperatively. LIMITATIONS: This study was limited by its retrospective and nonrandomized nature. CONCLUSIONS: Although administration of stress dose steroids is not related to increased postoperative complications, the steroids do not appear to affect adrenal insufficiency outcomes. Patients who were treated with steroids for ulcerative colitis should be monitored carefully in the perioperative and early postoperative periods for signs of adrenal insufficiency, regardless of the steroid regimen used.

Presacral tumors: how do they compare in pediatric and adult patients?

UNLABELLED: Presacral tumors are rare with few published studies in the literature. It is unknown whether the course of the disease and the required treatment differs between pediatric and adult patients. The aim of the study was to compare presenting symptoms, surgical treatment, pathology, and recurrence rates of presacral tumors in these two groups. MATERIAL AND METHODS: An IRB-approved chart review was conducted for patients diagnosed with a presacral tumor at the Cleveland Clinic between 1981 and 2011. Symptoms, physical exam, surgical details, tumor histology, and outcomes were collected as part of the review. Patients were divided into two groups: pediatric (< 18 years n=14) and adult (≥ 18 years n=50). RESULTS: The most common symptom was a mass in pediatric and pain in adult patients. The most common pediatric primary tumor was a teratoma (n=5, 36%) versus Hamartoma/tailgut cyst (n=17, 34%) in adult patients. Three pediatric and nine adult patients developed tumor recurrences, and 2/14 (14%) pediatric and 4/50 (8%) adult patients developed metastases. CONCLUSIONS: This study summarizes the presentation, evaluation and management of pediatric and adult presacral tumors at tertiary referral center. The presentation, histology, and management of presacral tumors vary depending upon whether they occur in pediatric or adult patients and recognition of potential differences may influence management.