Peri-operative Replacement of Exogenous Steroids (PREdS): a national audit of current peri-operative prescribing for patients taking therapeutic steroids.

Approximately 1.3% of audited surgical patients were taking therapeutic corticosteroids.

• Operations for 21,731 patients were audited across 59 Trusts over 14 consecutive days.
• 277 of 21,731 (1.3%) patients were taking therapeutic corticosteroids.
• This is consistent with the estimated ~1% of the UK population taking oral corticosteroids for ≥28 days each year.

The majority of patients taking therapeutic corticosteroids had high ASA physical status and most underwent elective procedures.

• 201/277 (73%) were ASA physical status ≥3.
• 184/277 (66%) underwent elective procedures.
• 252/277 (91%) were prescribed prednisolone pre-operatively.
• 219/277 (79%) were prescribed ≥5 mg oral prednisolone equivalents pre-operatively.

Overall peri-operative prescribing compliance with Association of Anaesthetists' 2020 guidelines was very low at 9%.

• Only 19/219 (9%) patients prescribed ≥5 mg oral prednisolone equivalents received fully compliant peri-operative glucocorticoid supplementation.
• A similar proportion, 30/219 (14%), received no supplementation at all.
• These findings applied to the subgroup of patients in whom supplementary corticosteroid would be indicated per guidelines.

Pre-operative glucocorticoid supplementation was more common than post-operative supplementation, but guideline-compliant rates were low for both.

• 186/219 (85%) of patients prescribed ≥5 mg oral prednisolone equivalents received pre-operative glucocorticoid supplementation.
• Only 67/219 (31%) received pre-operative supplementation according to the guidelines.
• 97/219 (42%) received post-operative supplementation.
• Only 43/219 (20%) received post-operative supplementation according to the guidelines.

A substantial proportion of patients taking sub-threshold doses of corticosteroids received inappropriate supplementation.

• 28/58 (48%) of patients taking <5 mg oral prednisolone equivalents pre-operatively received inappropriate supplementation.
• Per guidelines, supplementary corticosteroid is not indicated for patients in this lower-dose group.
• This indicates overcorrection as well as undercorrection occurring within peri-operative prescribing practice.

Self-reported guideline use by anaesthetists did not translate into compliant prescribing.

• 125/277 (45%) of anaesthetists reported using Association of Anaesthetists' guidelines.
• Despite this, adherence was found in only 27/125 (22%) of those patients whose anaesthetists reported guideline use.
• This discrepancy suggests a gap between awareness and correct application of the guidelines.