Postoperative systemic inflammatory dysregulation and corticosteroids: a narrative review
C R Bain1, P S Myles1, T Corcoran2
1Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Anaesthesia
|October 29, 2022
Summary
Postoperative systemic inflammatory dysregulation increases surgical complication risks and hospital stay. Corticosteroid supplementation may reduce these risks, especially in high-risk patients, requiring tailored treatment strategies.
Area of Science:
- Immunology
- Surgical Pathology
- Pharmacology
Background:
- Surgical injury can trigger a harmful, dysregulated inflammatory-immune response in some patients.
- This postoperative systemic inflammatory dysregulation is linked to increased complications and prolonged hospital stays.
Purpose of the Study:
- To review the evolution, measurement, and prediction of postoperative systemic inflammatory dysregulation.
- To assess glucocorticoid actions and heterogeneous responses to corticosteroid supplementation.
- To evaluate the safety and efficacy of corticosteroid supplementation in mitigating surgical complications.
Main Methods:
- Narrative review of existing literature.
- Analysis of glucocorticoid mechanisms.
- Appraisal of evidence on corticosteroid supplementation safety and benefits.
Main Results:
- Postoperative systemic inflammatory dysregulation is a distinct pathophysiological response, not a healthy host response.
- Corticosteroid supplementation appears safe and may reduce major complications and mortality.
- Heterogeneous patient responses to corticosteroids necessitate tailored therapeutic approaches.
Conclusions:
- Future clinical trials should identify high-risk patients for peri-operative inflammatory complications.
- Corticosteroid regimens should be personalized based on initial risk and evolving inflammatory markers.
- Targeted corticosteroid therapy can potentially improve outcomes for at-risk surgical patients.
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