Risks and Management of Glucocorticoid Therapy for Patients with Rheumatic Disease Having Surgery.

PURPOSE OF REVIEW: The purpose of this review was to identify and characterize the diverse risks and benefits of glucocorticoid use in the perioperative period in patients with rheumatic diseases.

RECENT FINDINGS: Glucocorticoids increase the risk of surgical site infection, wound dehiscence, pneumonia, unplanned intubation and readmissions. The risk of perioperative adrenal insufficiency is rare. Guidelines specifically for knee and hip arthroplasties do not recommend stress dosing of steroids. Continuation of home doses of glucocorticoids is adequate for most patients. Stress dosing of glucocorticoids should be reserved for patients with biochemically confirmed adrenal dysfunction or are receiving supraphysiologic doses of glucocorticoids going for moderate to high-risk surgeries.