title: Does perioperative steroid use improve clinical outcomes in open repair of craniosynostosis?
abstract: BACKGROUND
  The benefits of routine perioperative steroid use to decrease facial edema, ecchymosis, pain, and reduced length of hospitalization have been reported for many procedures. The role of perioperative steroids after open craniosynostosis surgery remains understudied. The purpose of our study was to assess the safety and efficacy of perioperative steroid administration in open repair of craniosynostosis based on current published clinical evidence.
  
  
  METHODS
  A systematic review of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane library databases using inclusion and exclusion criteria was performed for articles that studied the efficacy of perioperative steroid use in craniosynostosis patients receiving open cranial repair surgery.
  
  
  RESULTS
  Our review yielded 149 unique citations. One hundred thirty-nine titles were excluded based on predefined criteria. Ten abstracts and 4 articles (n = 14) qualified for full-text screening. Two additional relevant articles were identified using references. Three observational studies were eligible for data abstraction. A Cohen κ coefficient score of 0.88 demonstrated high interrater agreement throughout the screening process. Clinical benefits in this specific population observed were improved control of postoperative edema, earlier time to eye opening, and reduced length of hospital stay. The timing, method, and technique of steroid administration varied between studies.
  
  
  CONCLUSIONS
  The reviewed literature supports a clinical benefit following administration of perioperative steroids for open repair surgery of craniosynostosis. However, the current level of evidence on safety and efficacy remains limited in rigor and volume. Further randomized trials are necessary prior to recommending routine steroid use in our study population.
  
  
  METHODS
  therapeutic, level III.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland; and †Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom.
authors.forename: Anne Tong Jia
authors.initials: AT
authors.lastname: Wei
authors.forename: Chris
authors.initials: C
authors.lastname: Madsen
authors.forename: Arwa
authors.initials: A
authors.lastname: Al-Sheemy
authors.forename: Anand Raj
authors.initials: AR
authors.lastname: Kumar
mesh_terms: D003398:Craniosynostoses / Q000188:drug therapy* / Q000601:surgery*; D004438:Ecchymosis / Q000517:prevention & control; D004487:Edema / Q000517:prevention & control; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D059035:Perioperative Period
chemical_list: D005938:Glucocorticoids