Impact of Prophylactic Corticosteroid Use on In-hospital Mortality and Respiratory Failure After Esophagectomy for Esophageal Cancer: Nationwide Inpatient Data Study in Japan.

Objective: To assess the effect of preoperative prophylactic corticosteroid use on short-term outcomes after oncologic esophagectomy.
Background: Previous studies have shown that prophylactic corticosteroid use may decrease the risk of respiratory failure following esophagectomy by attenuating the perioperative systemic inflammation response. However, its effectiveness has been controversial, and its impact on mortality remains unknown.
Methods: Data of patients who underwent oncologic esophagectomy between July 2010 and March 2019 were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting, propensity score matching, and instrumental variable analyses were performed to investigate the associations between prophylactic corticosteroid use and short-term outcomes, such as in-hospital mortality and respiratory failure, adjusting for potential confounders.
Results: Among 35,501 eligible patients, prophylactic corticosteroids were used in 22,620 (63.7%) patients. In-hospital mortality, respiratory failure, and severe respiratory failure occurred in 924 (2.6%), 5440 (15.3%), and 2861 (8.1%) patients, respectively. In stabilized inverse probability of treatment weighting analyses, corticosteroids were significantly associated with decreased in-hospital mortality [odds ratio (OR)=0.80; 95% confidence interval (CI): 0.69-0.93], respiratory failure (OR=0.84; 95% CI: 0.79-0.90), and severe respiratory failure (OR=0.87; 95% CI: 0.80-0.95). Corticosteroids were also associated with decreased postoperative length of stay and total hospitalization costs. The proportion of anastomotic leakage did not differ with the use of Propensity score matching and instrumental variable analysis demonstrated similar results.
Conclusions: Prophylactic corticosteroid use in oncologic esophagectomy was associated with lower in-hospital mortality as well as decreased respiratory failure and severe respiratory failure, suggesting a potential benefit for preoperative corticosteroid use in esophagectomy.
Competing Interests: Y.K. has received grants from Chugai Pharmaceutical Co. Ltd, Taiho Pharmaceutical Co. Ltd, Yakult Honsha Co. Ltd, Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Co. Ltd, Ono Pharmaceutical Co. Ltd, Tsumura & Co., Kaken Pharmaceutical Co. Ltd, Dainippon Sumitomo Pharma Co. Ltd, EA Pharma Co. Ltd, Eisai Co. Ltd, Otsuka Pharmaceutical Factory Inc., Medicon Inc., Kyowa Hakko Kirin Co. Ltd, Takeda Pharmaceutical Co. Ltd, Toyama Chemical Co. Ltd, Astellas Pharma Inc., Teijin Pharma Limited, Nihon Pharmaceutical Co. Ltd, and Nippon Covidien Inc. as well as lecture fees from Chugai Pharmaceutical Co. Ltd, Taiho Pharmaceutical Co. Ltd, Asahi Kasei Pharma Co. Ltd, Otsuka Pharmaceutical Factory Inc., Ono Pharmaceutical Co. Ltd, Shionogi & Co. Ltd, AstraZeneca K.K., Nippon Covidien Inc., Ethicon Inc., Bristol-Myers Squibb K.K., and Olympus Co. outside the submitted work. The remaining authors report no conflicts of interest.
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