Steroids for surgery during cardiopulmonary bypass in adults: a meta-analysis.
OBJECTIVE
To evaluate the effect of steroid administration on myocardial infarction (MI), stroke, renal insufficiency, death, intensive care (ICU) length of stay (LOS) and hospital LOS of patients undergoing cardiopulmonary bypass (CPB).


METHODS
Meta-analysis of parallel randomized controlled trials.


METHODS
University hospital.


METHODS
A search was conducted in PubMed, EMBASE, MEDLINE(R) and the Cochrane Central Register of Controlled Trials of studies on adults undergoing surgery with CPB who received steroid administration. Effect size (risk ratio or mean difference) for MI, stroke, renal insufficiency, death, ICU LOS, and hospital LOS were evaluated.


RESULTS
48 RCTs published between 1977 and 2012 were retained for analysis. Steroids had no effect on the MI risk ratio (RR) 0.91 (95% confidence interval [CI] 0.63, 1.32); death at 30 days RR 0.84 (0.59, 1.20); stroke RR 0.92 (0.60, 1.42) or renal insufficiency RR 0.83 (0.52, 1.32). Administration of steroids reduced ICU LOS (P = 0.00001; I(2) 87.5%) and hospital LOS (P = 0.03; I(2) 81.1%). Metaregressions showed that duration of steroid administration was correlated with the reduction in ICU LOS (P = 0.0004) and hospital LOS (P < 0.00001).


CONCLUSIONS
Increasing the duration of steroid administration may reduce ICU and hospital LOS greater than increasing the dose.
Department of Anesthesiology, University of Montreal, Montreal, QC, Canada H3C 3J7. Electronic address: joanneguay@bell.net.
Joanne
J
Guay
Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
E Andrew
EA
Ochroch
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D003422:Critical Care / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000517:prevention & control; D020521:Stroke / Q000517:prevention & control
D000305:Adrenal Cortex Hormones
Cardiopulmonary bypass; Hospital length of stay; Intensive care unit stay; Steroid administration