Reuters Health Information (2011-07-18): Glucocorticoids beneficial before major abdominal surgery: meta-analysis
Glucocorticoids beneficial before major abdominal surgery: meta-analysis
Last Updated: 2011-07-18 16:40:26 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Giving glucocorticoids before major abdominal surgery decreases complications and gets patients out of the hospital faster, say the authors of a new meta-analysis.
They attribute the effect to a dampening of the postoperative inflammatory response.
The "evidence remains a little thin in terms of overall patient numbers," the study's lead author, Dr. Sanket Srinivasa from Middlemore Hospital and the University of Auckland, New Zealand, told Reuters Health by email.
Even so, Dr. Srinivasa said, "the evidence that we now have gives us no reason to not use them to improve short term recovery and their clinical benefits seem real."
In a paper published online June 20th in the Annals of Surgery, the research team notes that randomized trials in patients undergoing major abdominal surgery have yielded mixed results regarding the short-term benefits -- and the safety -- of pre-op glucocorticoids.
In the new meta-analysis, pooled data from 11 randomized trials with 439 patients showed that glucocorticoid pretreatment significantly lowered the complication rate (odds ratio 0.37; P<0.01), with minimal heterogeneity in the results. Pretreatment also decreased infectious complications (OR = 0.35; P<0.01), with no heterogeneity in the results.
Hospital stay was shortened by 2 days, on average, with pretreatment (P = 0.01), albeit with high levels of heterogeneity. Treatment also reduced serum levels of the proinflammatory interleukin-6 (IL-6) on postoperative day 1 by a mean of 55 pg/mL (P<0.01), but again with high heterogeneity in studies.
In subset analyses, giving glucocorticoids before liver resection significantly decreased complications (OR = 0.28) and shortened mean length of stay by about 2 days. Pretreatment also tended to reduce complications in colorectal surgery (OR = 0.45) along with mean length of hospital stay by about 1 day.
Glucocorticoids did not appear to increase the risk of anastomotic leaks in colorectal surgery, the investigators report. However, due to the small number of patients, the influence of glucocorticoids on anastomotic leaks cannot be definitively stated, they say.
But since overall the meta-analysis showed positive effects, the research team believes pre-op glucocorticoids should be used routinely in "suitable patients" while longer-term studies are conducted.
But the authors of a commentary call for caution. Dr. Robert Udelsman and Maria Ciarleglio from Yale University School of Medicine in New Haven, Connecticut applaud the researchers' use of meta-analysis to evaluate the data.
However, they say, the results are constrained by the studies employed, the small total patient sample and the different types and doses of glucocorticoids used in the studies.
The results of this meta-analysis "do not seem to justify a major change in clinical care," the authors say.
Dr. Udelsman and Dr. Ciarleglio also remind readers that elevated glucocorticoids are associated with "significant detrimental effects including hyperglycemia, impaired wound healing and an increased propensity to infection."
Ann Surg 2011.