Effect of systemic steroids on post-tonsillectomy bleeding and reinterventions: systematic review and meta-analysis of randomised controlled trials

• Published in: BMJ (Online) Vol. 345; no. aug28 1; p. e5389
• Main Authors: Plante, Jennifer, Turgeon, Alexis F, Zarychanski, Ryan, Lauzier, François, Vigneault, Louise, Moore, Lynne, Boutin, Amélie, Fergusson, Dean A
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 28.08.2012; BMJ Publishing Group LTD; BMJ Publishing Group Ltd
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adults; Bias; Bleeding; Blood transfusion; Clinical trials; Clinical trials (epidemiology); Collaboration; Data collection; Dissection; Ear; Epidemiologic studies; Evidence-based medicine; Haematology (incl blood transfusion); Humans; Internet; Meta-analysis; Nausea; nose and throat/otolaryngology; Otolaryngology / ENT; Outcome and Process Assessment (Health Care); Pain; Pain, Postoperative - prevention & control; Pediatrics; Postoperative Care - adverse effects; Postoperative Care - methods; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - epidemiology; Postoperative Nausea and Vomiting - prevention & control; Randomized Controlled Trials as Topic; Reoperation - statistics & numerical data; Risk Assessment; Sensitivity analysis; Steroid hormones; Steroids; Surgeons; Systematic review; Tonsillectomy - adverse effects; Tonsillectomy - methods; Tonsillectomy - statistics & numerical data; Vomiting
• ISSN: 0959-8138; 1756-1833; 1756-1833
• DOI: 10.1136/bmj.e5389

Objective To evaluate the risk of postoperative bleeding and reintervention with the use of systemic steroids in patients undergoing tonsillectomy.Design Systematic review and meta-analysis of randomised controlled trials.Data sources Medline, Embase, Cochrane Library, Scopus, Web of Science, Intute, Biosis, OpenSIGLE, National Technical Information Service, and Google Scholar were searched. References from reviews identified in the search and from included studies were scanned.Review methods Randomised controlled trials comparing the administration of systemic steroids during tonsillectomy with any other comparator were eligible. Primary outcome was postoperative bleeding. Secondary outcomes were the rate of admission for a bleeding episode, reintervention for a bleeding episode, blood transfusion, and mortality.Results Of 1387 citations identified, 29 randomised controlled trials (n=2674) met all eligibility criteria. Seven studies presented a low risk of bias, but none was specifically designed to systematically identify postoperative bleeding. Administration of systemic steroids did not significantly increase the incidence of post-tonsillectomy bleeding (29 studies, n=2674 patients, odds ratio 0.96 (95% confidence interval 0.66 to 1.40), I²=0%). We observed a significant increase in the incidence of operative reinterventions for bleeding episodes in patients who received systemic steroids (12, n=1178, 2.27 (1.03 to 4.99), I²=0%). No deaths were reported. Sensitivity analyses were consistent with the findings.Conclusions Although systemic steroids do not appear to increase bleeding events after tonsillectomy, their use is associated with a raised incidence of operative reinterventions for bleeding episodes, which may be related to increased severity of bleeding events. Systemic steroids should be used with caution, and the risks and benefits weighed, for the prevention of postoperative nausea and vomiting after tonsillectomy before further research is performed to clarify their condition of use.