Association Between Preoperative Steroid Use and Short-Term Outcomes Following Pancreaticoduodenectomy: A Nationwide Analysis Using the National Clinical Database.

Background: Pancreaticoduodenectomy (PD) carries a high risk of postoperative complications. Although steroids are widely prescribed for various chronic diseases, the specific impact after PD remains unclear. This study evaluated the association between preoperative chronic steroid use and short-term outcomes following PD. Methods: This retrospective cohort study used Japanese National Clinical Database data from 2019 to 2022. Patients undergoing PD were categorized by preoperative chronic steroid use. To account for varying background factors, three multivariable regression models with different adjustment levels (Models 1-3) were constructed. Results: Of 40 878 patients, 521 (1.3%) had chronic steroid use prior to PD. The steroid group had higher crude rates of adverse outcomes, including postoperative pancreatic fistula (POPF; 30.7% vs. 22.1%) and severe complications (7.7% vs. 4.4%). In the most extensively adjusted multivariable model (Model 3), preoperative steroid use remained a significant factor associated with POPF (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.47-2.20) and severe complications (OR 1.71, 95% CI: 1.22-2.40). The adverse impacts on infectious complications and surgery-related mortality were also consistently significant across all models, whereas preoperative steroid use was not significantly associated with re-operation in any of the models. Conclusions: Preoperative chronic steroid use is significantly associated with poor short-term outcomes after PD, including POPF, severe complications, infectious complications, and mortality. These risks remained consistent regardless of adjustment level, highlighting the need for intensive perioperative management.