Protective effects of steroids in cardiac surgery: a meta-analysis of randomized
double-blind trials.
Author(s): Cappabianca G, Rotunno C, de Luca Tupputi Schinosa L, Ranieri VM, Paparella D.
Affiliation(s): Division of Cardiac Surgery, Department of Emergency and Organ Transplant,
University of Bari, Bari, Italy.
Publication date & source: 2011, J Cardiothorac Vasc Anesth. , 25(1):156-65
OBJECTIVE: Cardiac surgery and cardiopulmonary bypass (CPB) induce an acute
inflammatory response contributing to postoperative morbidity. The use of
steroids as anti-inflammatory agents in surgery using CPB has been tested in many
trials and has been shown to have good anti-inflammatory effects but no clear
clinical advantages for the lack of an adequately powered sample size. The aim of
this study was to evaluate the effects of steroid treatment on mortality and
morbidity after cardiac surgery.
DESIGN: A systematic meta-analysis of randomized double-blind trials (RDBs).
SETTING: A university hospital.
PARTICIPANTS: Adult patients who underwent cardiac surgery.
MEASUREMENTS AND MAIN RESULTS: A trial search was performed through PubMed and
Cochrane databases from 1966 to January 2009. Among 104 clinical trials reviewed,
31 RDB trials (1,974 patients) were considered suitable to be analyzed. A quality
assessment of the trials was performed using the Jadad score. The types of
steroid used in these trials were methylprednisolone (51.4%), dexamethasone
(34.3%), hydrocortisone (5.7%), prednisolone (2.9%), or a combination of
methylprednisolone and dexamethasone (5.7%). Steroid prophylaxis provided a
protective effect preventing postoperative atrial fibrillation (odds ratio =
0.56; confidence interval [CI] 0.44-0.72, p < 0.0001), reducing postoperative
blood loss (mean difference = -204.2 mL; CI from -287.4 to -121 mL; p < 0.0001),
and reducing intensive care unit (mean difference = -6.6 hours; CI from -10.5 to
-2.7 hours, p = 0.0007) and overall hospital stay (mean difference = -0.8 days;
CI from -1.4 to -0.2 days, p = 0.01). Steroid prophylaxis had no effect on
postoperative mortality, mechanical ventilation duration, re-exploration for
bleeding, and postoperative infection.
CONCLUSIONS: A systematic review of RDB trials reveals that steroid prophylaxis
may reduce morbidity after cardiac surgery and does not increase the risk of
postoperative infections.
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