Steroids for surgery during cardiopulmonary bypass in adults: a meta-analysis

• Published in: Journal of clinical anesthesia Vol. 26; no. 1; pp. 36 - 45
• Main Authors: Guay, Joanne, MD, Ochroch, E. Andrew, MD, MSCE
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2014; Elsevier; Elsevier Limited
• Subjects: Acute coronary syndromes; Adrenal Cortex Hormones - therapeutic use; Adult; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - mortality; Confidence intervals; Critical Care - statistics & numerical data; Hospital length of stay; Humans; Intensive care; Intensive care unit stay; Intubation; Length of Stay - statistics & numerical data; Medical sciences; Meta-analysis; Myocardial Infarction - prevention & control; Pain Medicine; Postoperative Complications - prevention & control; Preoperative Care - methods; Randomized Controlled Trials as Topic; Renal Insufficiency - prevention & control; Steroid administration; Steroids; Stroke; Stroke - prevention & control; Studies; Surgery; Cardiopulmonary bypass; Hospital length of stay; Intensive care unit stay; Steroid administration; Human; Steroid; Surgery; Adult; Hospital; Intensive care unit; Metaanalysis
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.08.006

Abstract Study Objective To evaluate the effect of steroid administration on myocardial infarction (MI), stroke, renal insufficiency, death, intensive care (ICU) length of stay (LOS) and hospital LOS of patients undergoing cardiopulmonary bypass (CPB). Design Meta-analysis of parallel randomized controlled trials. Setting University hospital. Meaurements A search was conducted in PubMed, EMBASE, MEDLINE(R) and the Cochrane Central Register of Controlled Trials of studies on adults undergoing surgery with CPB who received steroid administration. Effect size (risk ratio or mean difference) for MI, stroke, renal insufficiency, death, ICU LOS, and hospital LOS were evaluated. Main Results 48 RCTs published between 1977 and 2012 were retained for analysis. Steroids had no effect on the MI risk ratio (RR) 0.91 (95% confidence interval [CI] 0.63, 1.32); death at 30 days RR 0.84 (0.59, 1.20); stroke RR 0.92 (0.60, 1.42) or renal insufficiency RR 0.83 (0.52, 1.32). Administration of steroids reduced ICU LOS ( P = 0.00001; I2 87.5%) and hospital LOS ( P = 0.03; I2 81.1%). Metaregressions showed that duration of steroid administration was correlated with the reduction in ICU LOS ( P = 0.0004) and hospital LOS ( P < 0.00001). Conclusions Increasing the duration of steroid administration may reduce ICU and hospital LOS greater than increasing the dose.