{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:39:32Z","timestamp":1792417172684,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Pancreaticoduodenectomy (PD) carries a high risk of postoperative complications. Although steroids are widely prescribed for various chronic diseases, the specific impact after PD remains unclear. This study evaluated the association between preoperative chronic steroid use and short\u2010term outcomes following PD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study used Japanese National Clinical Database data from 2019 to 2022. Patients undergoing PD were categorized by preoperative chronic steroid use. To account for varying background factors, three multivariable regression models with different adjustment levels (Models 1\u20133) were constructed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 40\u2009878 patients, 521 (1.3%) had chronic steroid use prior to PD. The steroid group had higher crude rates of adverse outcomes, including postoperative pancreatic fistula (POPF; 30.7% vs. 22.1%) and severe complications (7.7% vs. 4.4%). In the most extensively adjusted multivariable model (Model 3), preoperative steroid use remained a significant factor associated with POPF (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.47\u20132.20) and severe complications (OR 1.71, 95% CI: 1.22\u20132.40). The adverse impacts on infectious complications and surgery\u2010related mortality were also consistently significant across all models, whereas preoperative steroid use was not significantly associated with re\u2010operation in any of the models.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Preoperative chronic steroid use is significantly associated with poor short\u2010term outcomes after PD, including POPF, severe complications, infectious complications, and mortality. These risks remained consistent regardless of adjustment level, highlighting the need for intensive perioperative management.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ags3.70286","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:41:23Z","timestamp":1792413683000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Preoperative Steroid Use and Short\u2010Term Outcomes Following Pancreaticoduodenectomy: A Nationwide Analysis Using the National Clinical Database"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4432-060X","authenticated-orcid":false,"given":"Yoshito","family":"Tomimaru","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery, Graduate School of Medicine The University of Osaka Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment, Graduate School of Medicine The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment, Graduate School of Medicine The University of Tokyo Tokyo Japan"},{"name":"Department of Health Data Science Tohoku University Graduate School of Medicine Sendai Miyagi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruhide","family":"Ishigame","sequence":"additional","affiliation":[{"name":"The Japanese Society of Gastroenterological Surgery Tokyo Japan"},{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic and Transplant Surgery and Fukushima Medical University Fukushima, Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8600-1199","authenticated-orcid":false,"given":"Hideki","family":"Ueno","sequence":"additional","affiliation":[{"name":"The Japanese Society of Gastroenterological Surgery Tokyo Japan"},{"name":"Department of Surgery National Defense Medical College Tokorozawa Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7173-7945","authenticated-orcid":false,"given":"Ken","family":"Shirabe","sequence":"additional","affiliation":[{"name":"The Japanese Society of Gastroenterological Surgery Tokyo Japan"},{"name":"Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine Gunma University Maebashi Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-1129","authenticated-orcid":false,"given":"Hidetoshi","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Graduate School of Medicine The University of Osaka Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/00000658-198801000-00009","article-title":"The Complications of Pancreatectomy","volume":"207","author":"Trede M.","year":"1988","journal-title":"Annals of Surgery"},{"issue":"1","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jamcollsurg.2012.09.002","article-title":"A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula After Pancreatoduodenectomy","volume":"216","author":"Callery M. 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S.","year":"2023","journal-title":"American Journal of Surgery"},{"issue":"3","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.jamcollsurg.2005.10.019","article-title":"Risk Factors for Anastomotic Leakage After Surgery for Colorectal Cancer: Results of Prospective Surveillance","volume":"202","author":"Konishi T.","year":"2006","journal-title":"Journal of the American College of Surgeons"},{"issue":"3","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.amjsurg.2010.09.018","article-title":"Adverse Effects of Preoperative Steroid Use on Surgical Outcomes","volume":"201","author":"Ismael H.","year":"2011","journal-title":"American Journal of Surgery"},{"issue":"6","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.amjsurg.2015.07.002","article-title":"Impact of Chronic Steroid Use on Outcomes of Colorectal Surgery","volume":"210","author":"Moghadamyeghaneh Z.","year":"2015","journal-title":"American Journal of Surgery"},{"issue":"10","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1007\/s00595-023-02698-6","article-title":"Effects of the Preoperative Use and Dosage of Steroids on Postoperative Complications of Gastric Cancer Surgery","volume":"53","author":"Ri M.","year":"2023","journal-title":"Surgery Today"},{"issue":"1","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.soard.2015.10.086","article-title":"Expanded Indications for Bariatric Surgery: Should Patients on Chronic Steroids Be Offered Bariatric Procedures?","volume":"13","author":"Kaplan J. 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Analysis of a National Database","volume":"26","author":"Aziz H.","year":"2022","journal-title":"Journal of Gastrointestinal Surgery"},{"issue":"6","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1007\/s11605-022-05260-w","article-title":"Association Between Preoperative Steroids and Outcomes in Patients Undergoing Pancreaticoduodenectomy Using the National Surgical Quality Improvement Program","volume":"26","author":"Aziz H.","year":"2022","journal-title":"Journal of Gastrointestinal Surgery"},{"issue":"10","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1007\/s00595-025-03028-8","article-title":"Increased Risk of Postoperative Pancreatic Fistula in Patients With Chronic Steroid Usage Undergoing Pancreatectomy","volume":"55","author":"Fujii W.","year":"2025","journal-title":"Surgery Today"},{"issue":"4","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1002\/ags3.12258","article-title":"Surgical Outcomes of Gastroenterological Surgery in Japan: Report of the National Clinical Database 2011\u20102017","volume":"3","author":"Hasegawa H.","year":"2019","journal-title":"Annals of Gastroenterological Surgery"},{"issue":"3","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/ags3.12662","article-title":"Annual Report on National Clinical Database 2020 for Gastroenterological Surgery in Japan","volume":"7","author":"Kajiwara Y.","year":"2023","journal-title":"Annals of Gastroenterological Surgery"},{"issue":"5","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1002\/ags3.12462","article-title":"Surgical Outcomes in Gastroenterological Surgery in Japan: Report of the National Clinical Database 2011\u20102019","volume":"5","author":"Marubashi S.","year":"2021","journal-title":"Annals of Gastroenterological Surgery"},{"issue":"3","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00595-024-02980-1","article-title":"2023 National Clinical Database Annual Report by the Japan Surgical Society","volume":"55","author":"Yamamoto T.","year":"2025","journal-title":"Surgery Today"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1001\/jama.1961.03040420001001","article-title":"The Role of Anesthesia in Surgical Mortality","volume":"178","author":"Dripps R. 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