Key result
Perioperative intravenous steroids reduced the risk of postoperative morbidity compared with standard care or placebo in patients undergoing liver resection (RR 0.76; 95% CI 0.57-0.99; P=0.047).
Why the study?
Does perioperative administration of intravenous steroids reduce postoperative morbidity in patients undergoing liver resection?
Meta-Analysis
Does perioperative administration of intravenous steroids reduce postoperative morbidity in patients undergoing liver resection?
Relative Risk: 0.76 (95% CI 0.57–0.99)
p-value: p=0.047
Perioperative intravenous steroids significantly reduce postoperative morbidity and inflammatory markers in patients undergoing liver resection without increasing infectious complications.
Supports perioperative IV steroids to reduce morbidity after liver resection; extends RCT evidence via meta-analytic confirmation of net benefit.
BACKGROUND: Several therapeutic strategies, such as ischaemic preconditioning, intermittent or selective pedicle clamping and pharmacological interventions, have been explored to reduce morbidity caused by hepatic ischaemia-reperfusion injury and the surgical stress response. The role of steroids in this setting remains controversial. METHODS: A comprehensive literature search in MEDLINE, Embase and the Cochrane Register of Clinical Trials (CENTRAL) was conducted (1966 onwards), identifying studies comparing perioperative administration of intravenous steroids with standard care or placebo, in the setting of liver surgery. Randomized Controlled trials (RCTs) and non-RCTs were included. Critical appraisal and meta-analysis were carried out according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement. RESULTS: Six articles were included; five were RCTs. Pooling the results revealed that patients receiving intravenous glucocorticoids were 24 per cent less likely to suffer postoperative morbidity compared with controls (risk ratio 0.76, 95 per cent confidence interval 0.57 to 0.99; P = 0.047). The treated group experienced a significantly greater rise in early postoperative interleukin (IL) 10 levels compared with controls. In addition, steroids significantly reduced postoperative blood levels of bilirubin, and of inflammatory markers such as IL-6 and C-reactive protein. There was no evidence supporting a risk difference in infectious complications and wound healing between study groups. CONCLUSION: Perioperative steroids have a favourable impact on postoperative outcomes after liver resection.
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Orci et al. (2013) conducted a meta-analysis in liver resection. perioperative intravenous steroids vs. standard care or placebo was evaluated on postoperative morbidity (risk ratio 0.76, 95% CI 0.57 to 0.99, p=0.047). Perioperative intravenous steroids reduced the risk of postoperative morbidity compared with standard care or placebo in patients undergoing liver resection (RR 0.76; 95% CI 0.57-0.99; P=0.047).
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