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Annals of Surgery Journal Club
Interactive resource for surgery residents and surgeons to discuss and critically evaluate articles published in Annals of Surgery selected by a monthly guest expert who will review an article each month, offer questions and respond to reader's comments.
Tuesday, June 05, 2012
June Journal Club

Preoperative Glucocorticoid Use in Major Abdominal Surgery: Systematic Review and Meta-Analysis of Randomized Trials. Srinivasa, Sanket; Kahokehr, Arman A.; Yu, Tzu-Chieh; Hill, Andrew G. Annals of Surgery. 254(2):183-191, August 2011.

Summary: Srinivasa et al. (Ann Surg 2011; 254:183-192) reported a review and meta-analysis of randomized trials evaluating the preoperative use of glucocorticoids in major abdominal surgery.  They selected 11 randomized trials comprising 439 patients and presented a fixed effects meta-analysis for computing a pooled Mantel-Haenzel odds ratio across studies for the outcome of complications.  They concluded that preoperative glucocorticoid administration decreased complications and length of stay and suggested that glucocorticoids should be considered as a routine measure.


Question 1. Is this meta-analysis adequately powered to answer the fundamental question?  Does preoperative glucocorticoid administration decrease complication rates following major abdominal surgery?


 Question 2. Does the meta-analysis utilize relatively homogenous studies or is there a wide variance in trial design, dose, and half-life of the glucocorticoid employed?


 Question 3. Are the conclusions of the study appropriate and based upon the data presented?


Please feel free to comment on any or all of the questions above. We look forward to hearing from you, the Annals readers.


About the Author

Dr. David T Efron
Dr. Efron is an Associate Professor of Surgery, Anesthesiology & Critical Care Medicine and Emergency Medicine at the Johns Hopkins School of Medicine. He is the Director of Trauma and Chief of the Division of Acute Care Surgery (encompassing Trauma, Emergency Surgery and Surgical Critical Care) in The Johns Hopkins Hospital Department of Surgery. He is currently the Vice-Chair of the Maryland State Committee on Trauma. Dr. Efron’s current research interests are within the realm of regulation of inflammatory mediators of septic and post-injury states, particularly focusing on the role that statins play in this milieu. Dr. Efron carries additional interest in traumatic injury from interpersonal violence, measures of violence intensity, and trauma recidivism with an eye to prevention strategies.

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