title: Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials.
abstract: OBJECTIVE
  To determine the clinical safety and efficacy of preoperative glucocorticoid (GC) administration in major abdominal surgery with regards to short term outcomes.
  
  
  BACKGROUND
  Previous randomized controlled trials (RCTs) in major abdominal surgery have displayed conflicting results regarding the short-term benefits of preoperative GC administration. Importantly, the safety of this intervention has not been conclusively determined.
  
  
  METHODS
  A systematic review and quantitative meta-analysis was conducted of all RCTs exploring preoperative GC administration in major abdominal surgery for the endpoints of complications, hospital length of stay (LOS) and serum IL-6 on postoperative day one. Subset analyses by procedure were planned "a priori."
  
  
  RESULTS
  Eleven RCTs of moderate quality, comprising 439 patients in total, were included in the final analysis. Preoperative GC use decreased complications (OR = 0.37; 95% CI, 0.21-0.64; P < 0.01), LOS (mean = 1.97 days; 95% CI, -3.33 to -0.61; P = 0.01), and serum IL-6 (mean: -55 pg/mL; 95% CI, -82.30 to -27.91; P < 0.01). Preoperative GCs decreased complications in hepatic resection (OR = 0.28; 95% CI, 0.14-0.55; P < 0.01) and mean LOS (mean LOS: -2.66; 95% CI, -5.01 to -0.32; P = 0.03). GCs reduced mean LOS in patients undergoing colorectal surgery (mean LOS: -0.98; 95% CI, -1.67 to -0.27; P = 0.01). There was no difference in complication rates (OR: 0.45; 95% CI, 0.16-1.32; P = 0.15) or anastomotic leaks specifically.
  
  
  CONCLUSIONS
  Preoperative administration of GCs decreases complications and LOS after major abdominal surgery as a likely consequence of attenuating the postsurgical inflammatory response. There is no evidence of increased complications in colorectal surgery.
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand. sanketsri@gmail.com
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.forename: Arman A
authors.initials: AA
authors.lastname: Kahokehr
authors.forename: Tzu-Chieh
authors.initials: TC
authors.lastname: Yu
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000005:Abdomen / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D005938:Glucocorticoids / Q000008:administration & dosage*; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D012002:Rectal Diseases / Q000601:surgery; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000517:prevention & control
chemical_list: D005938:Glucocorticoids; D015850:Interleukin-6