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Annals of Surgery:
doi: 10.1097/SLA.0b013e3182261118
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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

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Abstract

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.

© 2011 Lippincott Williams & Wilkins, Inc.

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