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Perioperative Steroids




Risk Stratification


  • Definitely suppressed hypothalamic-pituitary-adrenal (HPA) axis → supplement 

    • those on prednisone > 20mg/day for >3 weeks in last year 

  • Definitely non-suppressed HPA axis → no need for supplementation

    • those on prednisone < 5mg/day for any duration

    • those on steroids < 3weeks in last year 

    • inhaled/topicals rarely cause suppression (although they can) 

  • Intermediate risk patients → consider HPA testing or base on patient status 

    • > 5mg/day but < 20mg/day 





  • Moderate risk surgery: hydrocortisone 50mg IV q8h X 3 doses 

  • High risk surgery: hydrocortisone 100mg IV q8h X 3 doses 

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