Obesity Surgery

, Volume 29, Issue 10, pp 3309–3315 | Cite as

Effects of Chronic Corticosteroid and Immunosuppressant Use in Patients Undergoing Bariatric Surgery

  • Joshua HeflerEmail author
  • Jerry Dang
  • Aryan Modasi
  • Noah Switzer
  • Daniel W. Birch
  • Shahzeer Karmali
Original Contributions



Chronic immunosuppression can put surgical patients at additional risk for complications, particularly infection. This is not a contraindication for patients undergoing bariatric surgery. However, with the increasing prevalence of bariatric surgery, it is important to characterize the additional risks for immunosuppressed patients.


The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry was used to identify immunosuppressed patients who had undergone bariatric surgery. Patients undergoing primary bariatric surgery (laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy) at an accredited institution between 2015 and 2017 were included. A multivariable regression analysis was performed, controlling for age, sex, procedure, and several other comorbidities. Overall 30-day incidence of major complications was the primary outcome. A secondary analysis compared outcomes amongst immunosuppressed patients by procedure type using a propensity-matched analysis. Propensity matching was performed based on preoperative comorbidities and bariatric procedure.


A total of 430,936 patients were included in the study. Of these, 7214 (1.7%) were chronically immunosuppressed. Our multivariable regression analysis found statistically higher odds of 30-day major complications (OR 1.39, 95% CI 1.25–1.55; p < 0.001), bleed (OR 1.49, 95% CI 1.24–1.80; p < 0.001) and anastomotic leak (OR 1.38, 95% CI 1.02–1.87; p = 0.037) amongst immunosuppressed patients. However, there was no difference between 30-day mortality (OR 1.15, 95% CI 0.64–2.07; p = 0.644). Our secondary analysis found higher rates of 30-day major complications for immunosuppressed patients undergoing gastric bypass (9.6% vs. 5.0%; p < 0.001).


Immunosuppressed patients are at higher risk of major complications when undergoing bariatric surgery, especially gastric bypass.


Immunosuppression Steroids 30-day complications Roux-en-Y gastric bypass Sleeve gastrectomy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

For this type of study, formal consent was not required.


  1. 1.
    Chang S-H, Stoll CRT, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149:275–87.CrossRefGoogle Scholar
  2. 2.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  3. 3.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefGoogle Scholar
  4. 4.
    Anstead GM. Steroids, retinoids, and wound healing. Adv Wound Care. 1998;11:277–85.PubMedGoogle Scholar
  5. 5.
    Levin AD, Wildenberg ME, van den Brink GR. Mechanism of action of anti-TNF therapy in inflammatory bowel disease. J Crohns Colitis. 2016;10:989–97.CrossRefGoogle Scholar
  6. 6.
    Pountos I, Giannoudis PV. Effect of methotrexate on bone and wound healing. Expert Opin Drug Saf. 2017;16:535–45.CrossRefGoogle Scholar
  7. 7.
    Yong SL, Coulthard P, Wrzosek A. Supplemental perioperative steroids for surgical patients with adrenal insufficiency. Cochrane Database Syst Rev. 2012;12:CD005367.PubMedGoogle Scholar
  8. 8.
    Eisenberg R. Immune compromise associated with biologics. In: Sullivan KE, Stiehm ER, editors. Stiehm’s immune deficiencies. Amsterdam: Elsevier; 2014. p. 889.CrossRefGoogle Scholar
  9. 9.
    American College of Surgeons. American Society for Metabolic & Bariatric Surgery, 2016. Resources for optimal care of the metabolic and bariatric surgery patient. 2016.Google Scholar
  10. 10.
    American College of Surgeons. American Society for Metabolic & Bariatric Surgery. User gide for the 2016 participant use data file (PUF). 2017Google Scholar
  11. 11.
    Becker S, Ichino A. Estimation of average treatment effects based on propensity scores. Stata J. 2002;2:358–77.CrossRefGoogle Scholar
  12. 12.
    Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424.CrossRefGoogle Scholar
  13. 13.
    Subramanian V, Saxena S, Kang J-Y, et al. Preoperative steroid use and risk of postoperative complications in patients with inflammatory bowel disease undergoing abdominal surgery. Am J Gastroenterol. 2008;103:2373–81.CrossRefGoogle Scholar
  14. 14.
    Sims SM, Kao AM, Spaniolas K, et al. Chronic immunosuppressant use in colorectal cancer patients worsens postoperative morbidity and mortality through septic complications in a propensity-matched analysis. Color Dis. 2018;21:156–63. Scholar
  15. 15.
    Lee HW, Lee JK, Oh SH, et al. Effect of perioperative systemic steroid treatment on patients with obstructive lung disease undergoing elective abdominal surgery. Clin Respir J. 2018;12:227–33.CrossRefGoogle Scholar
  16. 16.
    Elli EF, Gonzalez-Heredia R, Sanchez-Johnsen L, et al. Sleeve gastrectomy surgery in obese patients post-organ transplantation. Surg Obes Relat Dis. 2016;12:528–34.CrossRefGoogle Scholar
  17. 17.
    Kaplan JA, Schecter SC, Rogers SJ, et al. Expanded indications for bariatric surgery: should patients on chronic steroids be offered bariatric procedures? Surg Obes Relat Dis. 2017;13:35–40.CrossRefGoogle Scholar
  18. 18.
    Gallo G, Candilio G, De Luca E, et al. Bariatric surgery and rheumatic diseases: a literature review. Rev Recent Clin Trials. 2018;13:176–83.CrossRefGoogle Scholar
  19. 19.
    Lee H, Lee IS, Choue R. Obesity, inflammation and diet. Pediatr Gastroenterol Hepatol Nutr. 2013;16:143–52.CrossRefGoogle Scholar
  20. 20.
    Kumar SB, Hamilton BC, Wood SG, et al. Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? A comparison of 30-day complications using the MBSAQIP data registry. Surg Obes Relat Dis. 2018;14:264–9.CrossRefGoogle Scholar
  21. 21.
    Peterli R, Wölnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus roux-y-gastric bypass for morbid obesity – 3-year outcomes of the prospective randomized swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg. 2017;265:466–73.CrossRefGoogle Scholar
  22. 22.
    Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA. 2018;319:241–54.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Mackenzie Health Sciences CentreEdmontonCanada
  3. 3.Wexner Medical CenterThe Ohio State UniversityColumbusUSA

Personalised recommendations