Yu-Ting Hung

Background: Preoperative chronic corticosteroid use has been associated with an increased risk of postoperative complications. However, its association with postoperative outcomes following gastrointestinal surgery remains unclear. This systematic review and meta-analysis aimed to evaluate this association. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to September 1, 2026. Eligible observational cohort studies compared patients with and without preoperative chronic corticosteroid exposure; studies restricted to inflammatory bowel disease were excluded. Adjusted estimates were pooled using random-effects models with restricted maximum likelihood and Hartung-Knapp confidence intervals after outcome-specific exclusion of potentially overlapping cohorts. Risk of bias and certainty of evidence were assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. Results: Fourteen retrospective cohort studies were included, seven of which contributed to quantitative synthesis. Bariatric surgery accounted for 65.2% of reported participants. The primary mortality analysis included five studies comprising 776,681 patients after overlap exclusions. Preoperative exposure was associated with higher odds of 30-day mortality (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI] 1.26–1.81), readmission (aOR 1.26, 95% CI 1.07–1.48), reoperation (aOR 1.32, 95% CI 1.10–1.59), sepsis (aOR 1.40, 95% CI 1.36–1.43), and organ-space surgical site infection (SSI; aOR 1.26, 95% CI 1.16–1.37). No statistically significant associations were found for superficial or deep SSI. Mortality and sepsis associations persisted in corticosteroid-specific analyses; readmission, reoperation, and organ-space SSI findings were less consistent across sensitivity analyses. Individual SSI analyses included only two studies and predominantly reflected colorectal surgery. Composite outcomes were summarized narratively. Evidence certainty was low or very low. Conclusions: Preoperative chronic corticosteroid exposure, as defined in the included studies, was associated with higher odds of adverse postoperative outcomes. The associations with mortality and sepsis were more consistent across sensitivity analyses. Given the mixed exposure definitions and residual confounding, the observed associations cannot be attributed to corticosteroids alone or generalized to all gastrointestinal procedures. These findings may support careful perioperative risk stratification and postoperative monitoring in these patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359719 , identifier CRD420261359719.

BACKGROUND: Postpartum depression impacts maternal health, child development, and overall family well being. General anaesthesia has been suggested as a potential risk factor. OBJECTIVE: To assess the association between anaesthetic methods and postpartum depression in women undergoing Caesarean section. DESIGN: Systematic review with meta-analysis. DATA SOURCES: We searched PubMed, Embase and Web of Science through 16 April 2025, and included seven studies comprising 1 482 355 patients. ELIGIBILITY CRITERIA: Randomised controlled trials and cohort studies comparing postpartum depression outcomes in women undergoing Caesarean section with general anaesthesia versus non-general anaesthesia. RESULTS: Our results showed that general anaesthesia significantly increased the risk of both overall postpartum depression [odds ratio (OR) = 1.64, 95% confidence interval (CI), 1.23 to 2.19] and severe postpartum depression (OR = 1.41, 95% CI, 1.35 to 1.47). Subgroup analysis stratified by timing of postpartum depression diagnosis revealed an elevated risk within one-year postpartum (OR = 1.22, 95% CI, 1.02 to 1.46) and an even higher risk within seven-day postpartum (OR = 4.68, 95% CI, 1.21 to 18.09). CONCLUSION: These findings highlight the importance of anaesthetic choices for Caesarean section and suggest that minimising general anaesthesia exposure may optimise both physical and mental health outcomes.

Higher rates of postoperative complications have been found in preoperative chronic steroid users. However, the effects of preoperative chronic steroid use on outcomes in orthopedic surgery were unclear. We performed a systematic review of cohort studies examining the effects of chronic steroid use on postoperative outcomes following orthopedic surgery and searched PubMed, Embase, and CENTRAL through 29 April 2023. We included 17 studies with 1,546,562 patients. No increase in 30-day mortality (adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 0.64–3.09) and composite thromboembolic events (aOR 1.61, 95% CI 0.99–2.63) but increases in 30-day overall complications (aOR 1.42, 95% CI 1.16–1.75), wound dehiscence (aOR 2.91, 95% CI 1.49–5.66), infectious complications (any infection (aOR 1.61, 95% CI 1.44–1.80), sepsis (aOR 2.07, 95% CI 1.34–3.21), superficial surgical site infection (SSI) (aOR 1.73, 95% CI 1.03–2.89) and deep SSI (aOR 1.96, 95% CI 1.26–3.05)), re-admission (aOR 1.62, 95% CI 1.48–1.77), both 30-day (aOR 1.28, 95% CI 1.03–1.59) and 1-year re-operation (aOR 1.78, 95% CI 1.09–2.92), pulmonary embolism (aOR 5.94, 95% CI 1.52–23.29), and deep vein thrombosis (aOR 2.07, 95% CI 1.24–3.46) were detected in preoperative steroid users. An increased risk of adverse outcomes following orthopedic surgery in chronic steroid users was found.