OBJECTIVES : To examine the impact of perioperative inhaled corticosteroids (ICS) therapy on length-of-stay (LOS) and costs for high-respiratory-risk surgical patients in China.

METHODS : Adult inpatients with high-respiratory-risk surgeries (i.e. moderate to severe surgeries on brain, ear-nose-throat, orofacial, thyroid and thorax) between 1/1/2015 and 12/31/2015 were identified in Tianjin Urban Employee Basic Medical Insurance database. Patients were grouped into ICS or non-ICS cohort according to whether they received ICS (i.e. budesonide) therapy during the perioperative period of the index hospitalization. 1:1 Propensity Score Matching was applied to form matched pairs between the two cohorts regard to demographic, hospital and clinical characteristics including anesthesia type, surgery site, surgery complexity, blood transfusion volume, duration of mechanical ventilation. Comparisons of LOS between the matched cohorts were conducted in total and surgery site subgroups. The impact of perioperative ICS therapy on total costs and respiratory-related costs was estimated by generalized liner model (GLM).

RESULTS : A total of 6,109 hospital stays with high-respiratory-risk surgeries were identified, of which 1,732 received perioperative ICS therapy. 821 patients in non-ICS cohorts were selected and matched with 821 patients in ICS cohort, with no significant differences presented after matching. The mean age was 54 years and 43% were male in the matched cohorts. The mean LOS per hospitalization was 13.0±0.3 days in ICS cohort, which was significantly lower than the matched non-ICS cohort (14.8±0.4 days, p=0.001). In subgroup analysis, patients with thorax and ear-nose-throat surgeries gained more benefit from ICS therapy with the mean decreased LOS of 5.5 days and 1.1 days, respectively. GLM results shows that perioperative ICS therapy was associated with decreased total cost (Coef.=-0.053, p=0.039) and respiratory-related costs (Coef.=-0.070, p=0.006).

CONCLUSIONS : Perioperative ICS therapy was associated with decreased LOS and costs for patients with high-respiratory-risk surgeries in China.