Institutional members access full text with Ovid®

Preoperative Glucocorticoid Use in Major Abdominal Surgery: Systematic Review and Meta-Analysis of Randomized Trials

Srinivasa, Sanket MBChB; Kahokehr, Arman A. MBChB; Yu, Tzu-Chieh MBChB; Hill, Andrew G. MD, FRACS, FACS

doi: 10.1097/SLA.0b013e3182261118
Feature

Objective: To determine the clinical safety and efficacy of preoperative glucocorticoid (GC) administration in major abdominal surgery with regards to short term outcomes.

Background: Previous randomized controlled trials (RCTs) in major abdominal surgery have displayed conflicting results regarding the short-term benefits of preoperative GC administration. Importantly, the safety of this intervention has not been conclusively determined.

Methods: A systematic review and quantitative meta-analysis was conducted of all RCTs exploring preoperative GC administration in major abdominal surgery for the endpoints of complications, hospital length of stay (LOS) and serum IL-6 on postoperative day one. Subset analyses by procedure were planned “a priori.”

Results: Eleven RCTs of moderate quality, comprising 439 patients in total, were included in the final analysis. Preoperative GC use decreased complications (OR = 0.37; 95% CI, 0.21–0.64; P < 0.01), LOS (mean = 1.97 days; 95% CI, −3.33 to −0.61; P = 0.01), and serum IL-6 (mean: −55 pg/mL; 95% CI, −82.30 to −27.91; P < 0.01). Preoperative GCs decreased complications in hepatic resection (OR = 0.28; 95% CI, 0.14–0.55; P < 0.01) and mean LOS (mean LOS: −2.66; 95% CI, −5.01 to −0.32; P = 0.03). GCs reduced mean LOS in patients undergoing colorectal surgery (mean LOS: −0.98; 95% CI, −1.67 to −0.27; P = 0.01). There was no difference in complication rates (OR: 0.45; 95% CI, 0.16–1.32; P = 0.15) or anastomotic leaks specifically.

Conclusions: Preoperative administration of GCs decreases complications and LOS after major abdominal surgery as a likely consequence of attenuating the postsurgical inflammatory response. There is no evidence of increased complications in colorectal surgery.

This systematic review and meta-analysis of randomized controlled trials demonstrates preoperative glucocorticoid administration in major abdominal surgery decreased hospital length of stay and total complications. Serum IL-6 was also lower on postoperative day 1 in the treatment group. Subset analyses show that complications were not increased in colorectal surgery.

From the Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.

Reprints: Dr. Sanket Srinivasa, Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand. E-mail: sanketsri@gmail.com.

Sanket Srinivasa and Arman Kahokehr are recipients of the Auckland Medical Research Foundation Ruth Spencer Medical Research Fellowship.

© 2011 Lippincott Williams & Wilkins, Inc.