Annals of Surgery

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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 5, 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

Ronald B. Hirschl, M.D
Ronald B. Hirschl, M.D, is the Head of Pediatric Surgery at C.S. Mott Children’s Hospital at the University of Michigan. He is also a Director of the American Board of Surgery and Chair of the Pediatric Surgery Board. He is funded by the NIH to study long-term artificial lung support in Pediatric patients with chronic lung failure. Dr. Hirschl obtained his Masters of Science from the University of Michigan in Clinical Research Design and Statistical Analysis. He has been involved in a number of studies and trials on the topic of appendicitis.