{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T23:25:56Z","timestamp":1786922756108,"version":"build-2736575974"},"reference-count":27,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surgical Infections"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Corticosteroid use in septic shock remains controversial, with trials showing conflicting results. Most studies have been conducted in mixed medical\u2013surgical populations, limiting generalizability to surgical patients who face unique risks. We examined how timing of steroid administration affects outcomes in surgical intensive care unit patients with septic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this retrospective cohort study, we analyzed data from 13,512 surgical patients with septic shock using the TriNetX platform. Patients were categorized into four cohorts: no steroids (n = 8,180), any steroid therapy (n = 5,332), early therapy (\u226424 h, n = 2,911), and late therapy (&gt;24 h, n = 2,421). We conducted propensity-matched analyses examining 90-day mortality, infectious complications, and surgical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Early steroid administration was associated with lower 90-day mortality compared with no steroids (31.5% vs. 33.3%; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.62\u20130.88; p = 0.006), whereas late administration correlated with higher mortality (34.1% vs. 27.1%; HR: 1.26; 95% CI: 1.11\u20131.43; p &lt; 0.001). Steroids were associated with lower rates of surgical site infections (relative risk [RR]: 0.63; p = 0.032) and wound dehiscence (RR: 0.73; p = 0.019), but higher rates of pneumonia (RR: 1.22; p = 0.003), myopathy (RR: 2.25; p &lt; 0.001), and bowel ischemia (RR: 2.29; p = 0.008).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In surgical ICU patients with septic shock, the timing of steroid administration impacts outcomes. Early administration was associated with reduced mortality, whereas late administration correlated with increased mortality. Steroids demonstrated a complex profile of beneficial and adverse effects on post-surgical complications. These findings highlight the importance of timing of therapy in surgical septic shock and may help explain conflicting results from previous trials in mixed populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10962964261437315","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T09:01:05Z","timestamp":1775120465000},"page":"529-537","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Real-World Analysis of Hydrocortisone and Fludrocortisone Prescribing in Surgical Patients with Septic Shock"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8303-6636","authenticated-orcid":false,"given":"Arnav","family":"Mahajan","sequence":"first","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA."},{"name":"Department of Surgery, The MetroHealth System, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Beattie","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilam","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, MetroHealth Medical Center, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Surgery, The MetroHealth System, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa P.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Surgery, The MetroHealth System, Cleveland, Ohio, USA."},{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin E.","family":"Dvorak","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA."},{"name":"Department of Surgery, The MetroHealth System, Cleveland, Ohio, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200107000-00002"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1586\/eri.12.50"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000194725.48928.3A"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.45"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.19.2294"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000723"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006172"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705716"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705835"},{"issue":"1","key":"e_1_3_2_12_1","first-page":"e1000","article-title":"Corticosteroids in sepsis and septic shock: A systematic review, pairwise, and dose-response meta-analysis","volume":"6","author":"Pitre T","year":"2024","unstructured":"11.Pitre T, , Drover K, , Chaudhuri D, et al. Corticosteroids in sepsis and septic shock: A systematic review, pairwise, and dose-response meta-analysis. Crit Care Explor 2024;6(1):e1000.","journal-title":"Crit Care Explor"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003262"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002955"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000001651"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2018.12.016"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2010.09.018"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.8129"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.7.862"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071366"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-022-01021-9"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.29323"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2009.02752.x"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12490"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2011.1690"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znae130"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/147323000603400213"}],"container-title":["Surgical Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10962964261437315","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10962964261437315","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10962964261437315","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T23:16:37Z","timestamp":1786922197000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10962964261437315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":27,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,10,1]]}},"alternative-id":["10.1177\/10962964261437315"],"URL":"https:\/\/doi.org\/10.1177\/10962964261437315","relation":{},"ISSN":["1096-2964","1557-8674"],"issn-type":[{"value":"1096-2964","type":"print"},{"value":"1557-8674","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}