Of 79,985 patients, 73,765 (92%) were initially treated with intravenous steroids, whereas 6220 (8%) received oral treatment. We found that % (95% confidence interval [CI], %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients died during hospitalization, whereas % (95% CI, %-%) of the intravenously and % (95% CI, %-%) of the orally treated patients experienced the composite outcome. After multivariable adjustment, including the propensity for oral treatment, the risk of treatment failure among patients treated orally was not worse than for those treated intravenously (odds ratio [OR], ; 95% CI, -). In a propensity-matched analysis, the risk of treatment failure was significantly lower among orally treated patients (OR, ; 95% CI, -), as was length of stay and cost. Using an adaptation of the instrumental variable approach, increased rate of treatment with oral steroids was not associated with a change in the risk of treatment failure (OR for each 10% increase in hospital use of oral steroids, ; 95% CI, -). A total of 1356 (22%) patients initially treated with oral steroids were switched to intravenous therapy later in the hospitalization.
The final case study involved a 50-year-old male pro bodybuilder who went into surgery because of a malignant tumor found on his chest wall. 4 During surgery he got a few standard anesthetics, including propofol, the same drug that killed Michael Jackson. Of course, it was administered in hospital conditions by trained doctors. Despite that, within minutes of the insertion of a breathing tube, the bodybuilder’s blood pressure drastically dropped while his heartbeat rapidly increased. The doctors gave him drugs that raised his blood pressure, and he was stabilized; the surgery continued. Even though the bodybuilder had last used steroids 12 years prior to the surgery, the doctors attributed the surgical crisis to past steroid use.
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