Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials.
OBJECTIVE
Cardiac surgery and cardiopulmonary bypass (CPB) induce an acute inflammatory response contributing to postoperative morbidity. The use of steroids as anti-inflammatory agents in surgery using CPB has been tested in many trials and has been shown to have good anti-inflammatory effects but no clear clinical advantages for the lack of an adequately powered sample size. The aim of this study was to evaluate the effects of steroid treatment on mortality and morbidity after cardiac surgery.


METHODS
A systematic meta-analysis of randomized double-blind trials (RDBs).


METHODS
A university hospital.


METHODS
Adult patients who underwent cardiac surgery.


RESULTS
A trial search was performed through PubMed and Cochrane databases from 1966 to January 2009. Among 104 clinical trials reviewed, 31 RDB trials (1,974 patients) were considered suitable to be analyzed. A quality assessment of the trials was performed using the Jadad score. The types of steroid used in these trials were methylprednisolone (51.4%), dexamethasone (34.3%), hydrocortisone (5.7%), prednisolone (2.9%), or a combination of methylprednisolone and dexamethasone (5.7%). Steroid prophylaxis provided a protective effect preventing postoperative atrial fibrillation (odds ratio = 0.56; confidence interval [CI] 0.44-0.72, p < 0.0001), reducing postoperative blood loss (mean difference = -204.2 mL; CI from -287.4 to -121 mL; p < 0.0001), and reducing intensive care unit (mean difference = -6.6 hours; CI from -10.5 to -2.7 hours, p = 0.0007) and overall hospital stay (mean difference = -0.8 days; CI from -1.4 to -0.2 days, p = 0.01). Steroid prophylaxis had no effect on postoperative mortality, mechanical ventilation duration, re-exploration for bleeding, and postoperative infection.


CONCLUSIONS
A systematic review of RDB trials reveals that steroid prophylaxis may reduce morbidity after cardiac surgery and does not increase the risk of postoperative infections.
Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
Giangiuseppe
G
Cappabianca
Crescenzia
C
Rotunno
Luigi
L
de Luca Tupputi Schinosa
V Marco
VM
Ranieri
Domenico
D
Paparella
D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D003422:Critical Care / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012121:Respiration, Artificial; D013256:Steroids / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000453:epidemiology
D013256:Steroids