Corticosteroids administration to improve outcome in high-risk surgical patients

Postoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival. Major surgery is associated with a predictable and usually transient systemic inflammatory response (SIRS), depending on the magnitude of the surgical trauma. An excessive SIRS syndrome participates to the development of postoperative organ dysfunction, infection and mortality. Corticosteroids may decrease the postsurgical SIRS. This review aims to discuss recent findings on the use of corticosteroids in major surgery.

In acute medicine, several lines of evidence have shown that moderate doses of corticosteroids decrease the excessive inflammatory response, without inducing immunosuppression. Evidences from several meta-analyses suggest that intraoperative administration of corticosteroids during major surgery decreases postoperative infectious complications, without significant risk of anastomotic leakage, or bleeding complications.

At present, no large randomized controlled trial has been performed in patients undergoing major noncardiac surgery. However, despite the widespread use of corticosteroids to improve analgesia and reduce postoperative nausea or vomiting, concerns continue to be raised about their safety. At present, the safety profile for using short course of moderate dose of corticosteroids is good, but glycaemic control and natremia should be carefully monitored during the postoperative period.