Anesthesia Journal - Safety of Perioperative Glucocorticoids in Elective Noncardiac Surgery: A Systematic Review and Meta-analysis PDF
Andrew J. Toner, F.R.C.A.; Vyhunthan Ganeshanathan,
F.R.C.A.; Matthew T. Chan, F.A.N.Z.C.A.; Kwok M. Ho, Ph.D.; Tomas B. Corcoran,
M.D. (Res.)
Abstract
Background: Glucocorticoids are increasingly used
perioperatively, principally to prevent nausea and vomiting. Safety concerns
focus on the potential for hyperglycemia and increased infection. The authors
hypothesized that glucocorticoids predispose to such adverse outcomes in a
dose-dependent fashion after elective noncardiac surgery.
Methods: The authors conducted a systematic literature
search of the major medical databases from their inception to April 2016.
Randomized glucocorticoid trials in adults specifically reporting on a safety
outcome were included and meta-analyzed with Peto odds ratio method or the
quality effects model. Subanalyses were performed according to a dexamethasone
dose equivalent of low (less than 8 mg), medium (8 to 16 mg), and high (more than 16 mg). The primary endpoints of
any wound infection and peak perioperative glucose concentrations were subject
to meta-regression.
Results: Fifty-six trials from 18 countries were identified,
predominantly assessing dexamethasone. Glucocorticoids did not impact on any
wound infection (odds ratio, 0.8; 95% CI, 0.6 to 1.2) but did result in a
clinically unimportant increase in peak perioperative glucose concentration
(weighted mean difference, 20.0 mg/dl;
CI, 11.4 to 28.6; P < 0.001 or 1.1 mM; CI, 0.6 to 1.6). Glucocorticoids reduced
peak postoperative C-reactive protein concentrations (weighted mean difference,
−22.1 mg/l;
CI, −31.7 to −12.5; P < 0.001), but other adverse outcomes and length of
stay were unchanged. No dose–effect relationships were apparent.
Conclusions: The evidence at present does not highlight any
safety concerns with respect to the use of perioperative glucocorticoids and
subsequent infection, hyperglycemia, or other adverse outcomes. Nevertheless,
collated trials lacked sufficient surveillance and power to detect clinically
important differences in complications such as wound infection.
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