Peri-operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids

• Published in: Anaesthesia 2024-10, Vol.79 (10), p.1042-1052
• Main Authors: Barker, Oliver J H, Ramesh, Aravind V, Kangesan, Inthu, Barnes, Jonathan, Harrogate, Suzanne, Gupta, Swati, Reeves, Barnaby C, Gibbison, Ben
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adrenal Insufficiency - drug therapy; Adult; Aged; Aged, 80 and over; Corticoids; Corticosteroids; Dietary supplements; Equivalence; Female; Glucocorticoids; Glucocorticoids - administration & dosage; Glucocorticoids - therapeutic use; Guideline Adherence - statistics & numerical data; Guidelines; Hormone Replacement Therapy - methods; Humans; Male; Medical Audit - methods; Middle Aged; Perioperative Care - methods; Prednisolone; Prednisolone - therapeutic use; Steroid hormones; Steroids; Stress (physiology); United Kingdom; Young Adult
• ISSN: 0003-2409; 1365-2044; 1365-2044
• DOI: 10.1111/anae.16388

Approximately 1% of the UK population take oral corticosteroids for ≥ 28 days each year, for broadly two reasons: deficiency in corticosteroid requiring replacement; or therapeutic corticosteroid for inflammatory conditions. Acute deficiency can occur at times of physiological stress (e.g. surgery), potentially leading to major complications. The Association of Anaesthetists' 2020 consensus guideline provides detailed advice for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency. This national audit aimed to assess compliance with this guideline. Data were collected from 59 Trusts over 14 consecutive days for all eligible patients undergoing procedures under the care of an anaesthetist. Patients who were prescribed ≥ 5 mg oral prednisolone equivalents pre-operatively, in whom supplementary corticosteroid would be indicated, were compared with those prescribed