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Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review
S Sauerland1, M Nagelschmidt, P Mallmann
12nd Department of Surgery, University of Cologne, Germany. S.Sauerland@uni-koeln.de
Background:
A single preoperative high dose of methylprednisolone (15 to 30 mg/kg) has been advocated in surgery, because it may inhibit the surgical stress response and thereby improve postoperative outcome and convalescence. However, these potential clinical benefits must be weighed against possible adverse effects.
Objective:
To conduct a risk-benefit analysis using a meta-analysis, to compare complication rates and clinical advantages associated with the use of high dose methylprednisolone in surgical patients.
Methods:
Randomised controlled trials of high dose methylprednisolone in elective and trauma surgery were systematically searched for in various literature databases. Outcome data on adverse effects, postoperative pain and hospital stay were extracted and statistically pooled in fixed-effects meta-analyses.
Results:
We located 51 studies in elective cardiac and noncardiac surgery, as well as traumatology. Pooled data failed to show any significant increase in complication rates. In patients treated with corticosteroids, nonsignificantly more gastrointestinal bleeding and wound complications were observed; the 95% confidence interval boundaries of the numbers-needed-to-harm were 59 and 38, respectively. The only significant finding was a reduction of pulmonary complications (risk difference -3.5%; 95% confidence interval -1.0 to -6.1), mainly in trauma patients.
Conclusion:
For patients undergoing surgical procedures, a perioperative single-shot administration of high dose methylprednisolone is not associated with a significant increase in the incidence of adverse effects. In patients with multiple fractures, limited evidence suggests promising benefits of glucocorticoids on pulmonary complications.
Insights
High-dose methylprednisolone (MP) in surgery does not significantly increase complications. While not significantly increasing adverse effects, MP showed a reduction in pulmonary complications, particularly in trauma patients.
Area of Science:
- Pharmacology
- Surgical Science
- Clinical Trials
Background:
- High-dose methylprednisolone (MP) is proposed to mitigate surgical stress response, potentially improving outcomes.
- However, concerns exist regarding potential adverse effects of perioperative MP administration.
Purpose of the Study:
- To perform a risk-benefit analysis of high-dose MP in surgical patients.
- To compare complication rates and clinical benefits using a meta-analysis.
Main Methods:
- Systematic search of randomized controlled trials involving high-dose MP in elective and trauma surgery.
- Extraction and statistical pooling of outcome data on adverse events, pain, and hospital stay.
Main Results:
- Analysis of 51 studies revealed no significant increase in overall complication rates with MP.
- A trend towards more gastrointestinal bleeding and wound complications was observed, with NNH values of 59 and 38.
- A significant reduction in pulmonary complications was noted (risk difference -3.5%), primarily in trauma patients.
Conclusions:
- Perioperative single-dose high-dose MP is not linked to a significant rise in adverse effects in surgical patients.
- Limited evidence suggests potential benefits of glucocorticoids in reducing pulmonary complications for patients with multiple fractures.
