Effect of perioperative corticosteroid use on the incidence of postcardiothoracic surgery atrial fibrillation and length of stay.
BACKGROUND
While the mechanism underlying the development of post-cardiothoracic surgery atrial fibrillation has not been fully elucidated, it has been suggested that inflammation may play a causative role. Corticosteroids have been traditionally used to reduce inflammation, and when administered perioperatively, they may decrease the incidence of atrial fibrillation.


OBJECTIVE
The purpose of this study was to investigate the effects of corticosteroid administration on the incidence of post-cardiothoracic surgery atrial fibrillation and resultant hospital length of stay.


METHODS
A systematic literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews through July 2006 was conducted using specific search terms. A review of cardiology abstracts and a manual review of references were also performed. Studies that met the following criteria were included: randomized, controlled trials comparing patients receiving perioperative corticosteroids or placebo and reporting data on post-cardiothoracic surgery atrial fibrillation. A random-effects model was used.


RESULTS
Nine of the 1396 citations initially identified, representing 990 patients, met the inclusion criteria. Upon meta-analysis, corticosteroids significantly lowered patients' odds of developing post-cardiothoracic surgery atrial fibrillation by 45% (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.39-0.78) and reduced hospital length of stay by approximately 1.6 days (weighted mean difference -1.59; 95% CI -2.96 to -0.21). Reductions in the incidence of post-cardiothoracic surgery atrial fibrillation appeared greatest in patients receiving intermediate doses of corticosteroid (50-210 mg dexamethasone equivalent), while both lower (up to 8 mg) and higher (236-2850 mg) dosing resulted in blunted effects.


CONCLUSIONS
Corticosteroids appear to reduce the incidence of post-cardiothoracic surgery atrial fibrillation and shorten hospital length of stay in randomized controlled trials.
Baker
William L
WL
University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.
White
C Michael
CM
Kluger
Jeffrey
J
Denowitz
Aaron
A
Konecny
Christopher P
CP
Coleman
Craig I
CI
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015203:Reproducibility of Results; D012107:Research Design; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents