Steroid Administration Post-Prostatectomy

Perioperative Steroid Management Guidelines

The World Journal of Emergency Surgery recommends that steroids are not routinely administered post-prostatectomy unless the patient has been on chronic steroid therapy or has adrenal insufficiency 1, 2
There is no evidence supporting routine administration of steroids after prostatectomy for patients who are not on chronic steroid therapy 1, 2
Routine "push-dose" or "stress-dose" steroids are not recommended in the perioperative period for prostatectomy patients without adrenal insufficiency 1

Patients who are on corticosteroids at the time of surgery should continue their usual regimen and receive equivalent intravenous hydrocortisone while nil by mouth, as recommended by Gut 3, 4
Prednisolone 5 mg is equivalent to hydrocortisone 20 mg or methylprednisolone 4 mg, according to Gut 4
For patients on chronic steroids (≥5 mg prednisolone equivalent for 4+ weeks), intraoperative steroid replacement should be administered: hydrocortisone 100 mg IV at induction, followed by continuous infusion of 200 mg/24h, as recommended by Anaesthesia 5, 6
Postoperatively, these patients should receive hydrocortisone 200 mg/24h by IV infusion while nil by mouth, then resume enteral glucocorticoid at double the pre-surgical dose for 48 hours, according to Anaesthesia 5, 6
In the event of unexplained, fluid-unresponsive hypotension during or after prostatectomy, adrenal insufficiency should be considered, and a push dose of 100 mg IV hydrocortisone should be administered, followed by 50 mg hydrocortisone q6h if adrenal crisis is suspected 1, 7

Steroid therapy is associated with increased morbidity in surgical patients, including higher rates of infectious complications, anastomotic leaks, wound dehiscence, and longer hospital stays, according to Gut and World Journal of Emergency Surgery 4, 7

Assess if the patient has been on chronic steroid therapy (≥5 mg prednisolone equivalent for ≥4 weeks), and administer perioperative steroids according to guidelines above, as recommended by Anaesthesia 5, 6
If the patient has not been on chronic steroid therapy, do not administer routine steroids post-prostatectomy, according to World Journal of Emergency Surgery 1, 2
Monitor for signs of adrenal insufficiency (unexplained hypotension) and treat promptly if it occurs, as recommended by World Journal of Emergency Surgery 1