Protective effects of corticosteroids in coronary artery bypass graft surgery alone or combined with valvular surgery: an updated and comprehensive meta-analysis and systematic review

This systematic review with meta-analysis sought to determine the protective effects of corticosteroids on clinical outcomes following coronary artery bypass grafting (CABG).Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design.The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference with 95% confidence interval (CI) for calculating differences between mean values of duration of hospitalization in intervention and control groups.Values of P < 0.1 for Q-test or I 2 > 50% indicated significant heterogeneity between the studies.The literature search of all major databases retrieved 3735 studies.After screening, a total of 45 trials were identified that reported outcomes.Pooled analysis was performed on incidence of atrial fibrillation (OR of 0.71; 95% CI: 0.59-0.86;P = 0.000), stroke (OR of 1.61; 95% CI: 0.63-4.1;P = 0.3), infection (OR of 1.03; 95% CI: 0.68-1.5;P = 0.8), re-infarction (OR of 0.88; 95% CI: 0.47-1.63;P = 0.6), length of ventilation time [weighted mean difference (WMD) of 0.257; 95% CI: 0.10-0.41;P = 0.00], length of hospital stay (WMD of -0.48; 95% CI: -0.66 to -0.3; P = 0.000), amount of blood loss (WMD of -124.05;95% CI: -147.72 to -100.38;P = 0.00), re-exploration (OR of 1.25; 95% CI: 0.66-2.35;P = 0.4) and mortality (OR of 0.87; 95% CI: 0.46-1.64;P = 0.6).Overall, steroid prophylaxis in patients undergoing CABG could significantly reduce complications such as atrial fibrillation and length of hospital stay, but slightly increased the length of ventilation time.On the other hand, no significant impact on the incidence of infection was observed compared with the placebo.Keywords: Coronary artery bypass graft • Cardiopulmonary bypass • Complication • Clinical outcome • Atrial fibrillation and postoperative infections [5].Various studies have reported on the influence of corticosteroids on complications after cardiac surgery.However, data from randomized controlled trials (RCTs) are limited, and so far largely inconclusive.This systematic review with meta-analysis sought to determine the strength of evidence for the effects of steroids on hospital mortality, incidence of AF, infection, length of mechanical ventilation, ICU and hospital stay, postoperative blood loss and re-exploration for bleeding after CABG.