Perioperative corticosteroid administration: a systematic review and descriptive analysis.

Area of Science:

• Endocrinology
• Anesthesiology
• Surgical Care

Background:

• Perioperative corticosteroid use is common but lacks clear guidelines for non-cardiac surgery patients with prior or current corticosteroid exposure.
• Potential risks include hyperglycemia, infection, and impaired wound healing.

Purpose of the Study:

• To evaluate if perioperative corticosteroids reduce adrenal insufficiency incidence in adult non-cardiac surgery patients exposed to corticosteroids, compared to placebo or no intervention.

Main Methods:

• Systematic search of MEDLINE, PubMed, EMBASE, and Cochrane Library (1995-2017).
• Inclusion of randomized controlled trials (RCTs), cohort studies, case-studies, and systematic reviews.
• Independent quality assessment and data extraction by two authors with bias analysis.

Main Results:

• Included two RCTs (37 patients), five cohort studies (462 patients), and four systematic reviews.
• No significant difference in adrenal insufficiency incidence was found in RCTs or cohort studies.
• The overall quality of evidence was low.

Conclusions:

• Current evidence does not support perioperative corticosteroid supplementation to prevent adrenal insufficiency.
• Study limitations prevent definitive conclusions on the efficacy of perioperative corticosteroids versus placebo.