Has anyone had surgery and stopped steroids?

[Amber1414]

I have to have surgery on my foot after Christmas. The doctor wants me off Prednisone so I heal completely. I can't function if I go less than 5 mg without struggles to walk, get up the stairs, etc. What can anyone else tell me about similar situations? How long I need to stop before surgery and when I can start up again.

[MrsNails]

Hi Amber

Have a look at this discussion from a few days ago......

healthunlocked.com/pmrgcauk...

It will be very difficult for you to reduce your Prednisolone without the side effects you mention as above.

There are many people on the Forum who’ve had Surgery while on Prednisolone, myself included & were NOT asked to reduce my Prednisolone & actually had additional Hydrocortisone Cover in Theatre & Post Operatively.

Kind Regards

MrsN

[123mossie]

I’ve had a consultation with ortho surgeon today, I’m listed for hip replacement January. He wasn’t concerned about 6mgm steroid, no problem. You definately don’t want a flare that could affect your mobilisation post op, hope they see sense.

[piglette]

I have had two replacement hips both with the same surgeon. He seems to have a paranoid hatred of steroids. The first time I negotiated 5mg with him. The second time when he wanted zero again the anaesthetist wanted the dose doubled. The anaesthetist being a strong woman won. Just tell your surgeon you cannot live without your dose or you will be in screaming agony.

[Marilyn1959]

I had unexpected surgery following an accident. Steroids were not an issue with hospital staff and I was on higher dose at the time. Had them intravenously, then self medicated, using my own supply, whilst in hospital recovering, since I wanted to take them with breakfast and didn't want to wait for meds round. No probs at all.

[PMRnewbie2017]

Please also mention the dangers of adrenal insufficiency as I very much doubt your adrenals will be fully functional yet.

[PMRpro Ambassador]

So your surgeon is prepared to risk you becoming seriously ill? I think I might look for another opinion.

Looking at your history you have been on pred a long time, even if you did have a short period off it. The crux now is your adrenal function which will be impaired. You are unlikely to be able to get to zero pred successfully in the next 3 months and most endocrinologists and anaesthetists would be recommending an INCREASE in pred dose during the surgery period. Reducing the pred dose as the surgeon wants will not only lead to a flare in symptoms which could well affect your post op recovery and mobilisation but also put you are serious risk of an adrenal crisis - which would be increased as a result of the stress of surgery.

I have been on pred for 11+ years and last year had surgery for a pacemaker to be inserted - I healed perfectly. Many on the forum have had successful surgery while on pred - others have been told they must stop pred precipitately by one surgeon but when they looked around found one who was prepared to do the same op on the same dose. As Marilyn says - emergency surgery must be done on the current dose.

[Heron82]

I had a mastectomy and reconstruction on 5mg pd. However, it will depend what dose you are on. Feet have relatively poor vasculature compared to other areas of the body so there may be a greater risk of infection. You should speak with your rheumatologist about this and perhaps he can speak with your ortho surgeon? I've been told that on 15 mg pred the risks are too high.

[Casia]

The anaesthetist I had for my recent hip surgery asked me not to lower my pred before surgery, albeit Im on a very low dose (1.5mcg) and indeed gave me a massive shot of dexamethasone (a more powerful steroid) during the surgery to counter any potential inflammation. He said many countries do this during operations regardless of whether the patient has any inflammation related conditions. Incidentally dexamethasone is now being used in the U.K. for serious Covid patients.

[Amkoffee]

I don't understand doctors wanting you to be off Prednisone for surgery or for healing purposes. It's like they don't consider the fact that your inflammation will Skyrocket which can't be good for healing. I have had two major surgeries and they tell never told me to stop the prednisone.