title: Effects of Steroids on Quality of Recovery and Adverse Events after General Anesthesia: Meta-Analysis and Trial Sequential Analysis of Randomized Clinical Trials.
abstract: BACKGROUND
  Quality of recovery (QoR) after surgery is a relevant outcome. The early postoperative quality of recovery of a patient can be determined using the QoR-40 questionnaire. The aim of this meta-analysis and Trial Sequential Analysis was to determine if perioperative administration of glucocorticosteroids improved patients' quality of recovery after general anesthesia and if adverse events occurred.
  
  
  METHODS
  We searched six databases, including trial registration sites. Randomized clinical trials reporting the efficacy of glucocorticosteroids on quality of recovery evaluated using the QoR-40 after general anesthesia were eligible. The QoR-40 data were combined as the mean difference with confidence intervals using a random-effects model. The I2 statistic was used to assess heterogeneity. The quality of the trials was evaluated using the Cochrane methodology. Moreover, Trial Sequential Analysis was carried out to prevent the inflation of type 1 errors caused by multiple testing and sparse data. We also assessed adverse events.
  
  
  RESULTS
  Three randomized clinical trials (totaling 301 patients) were analyzed. The results from one published and four unpublished randomized clinical trials were unavailable. Dexamethasone was investigated in all three trials, and the results suggested that it significantly improved QoR-40 at postoperative day one scores compared with placebo (mean difference [95% confidence interval]: 14.2 points [10.4 to 18.1]; P < 0.001; I2 = 0%). We could not conduct sensitivity analysis because of the absence of trials with low risk of bias. The Trial Sequential Analysis-adjusted confidence interval was -1.6 to 30.0, indicating that further trials are required. The reporting of adverse events was insufficient.
  
  
  CONCLUSIONS
  These findings indicate that perioperative dexamethasone administration may improve short-term (i.e., one day) quality of recovery after general anesthesia and surgery. We need more randomized clinical trials with low risk of bias assessing the effects of glucocorticosteroids on quality of life, other outcomes, and adverse events. Updated systematic reviews should then be conducted.
  
  
  BACKGROUND
  University Hospital Medical Information Network Clinical Trials Registry: UMIN000015678.
authors.affiliation: Department of Anesthesiology, Kanagawa Children's Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan.|Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
authors.forename: Takahiro
authors.identifier: http://orcid.org/0000-0003-0613-511X
authors.initials: T
authors.lastname: Mihara
authors.affiliation: Department of Anesthesiology, Kanagawa Children's Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishii
authors.affiliation: Department of Anesthesiology, Kanagawa Children's Medical Center, Mutsukawa 2-138-4, Minami-ku, Yokohama, Japan.|Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
authors.forename: Koui
authors.initials: K
authors.lastname: Ka
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Goto
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D003907:Dexamethasone