Corticosteroid use in cardiac surgery: a systematic review and meta-analysis

Abstract

OBJECTIVES: This systematic review and meta-analysis seeks to determine whether corticosteroids are of beneficial use in cardiac surgery. DESIGN: A database search was conducted using PubMed and EMBASE for randomised controlled trials (RCTs) comparing steroid use with a placebo in adults undergoing cardiac surgery, between 1990-2018. The quality of each study was assessed using the Jadad scoring system, and only double-blind studies with a score ≥3 were included. 53 RCTs were identified, and 14 were considered suitable for analysis. RESULTS: The corticosteroids used in the studies were methylprednisolone (57.1%), dexamethasone (35.7%), and hydrocortisone (7.1%). Steroid use significantly reduced incidence of infection [relative risk (RR) 0.83; 95% confidence interval (CI) 0.84-1.06; P<0.0001; I2=75%] and length of hospital stay [mean difference -0.36; 95% CI -0.5 – -0.21; P<0.00001; I2=88%]. Incidence of new atrial fibrillation was significantly reduced [RR 0.94; 95% CI 0.89-1.06; P=0.03; I2=0%], but this outcome was no longer significant when only large studies were included [RR 0.96; 95% CI 0.90-1.01; P=0.13; I2=0%]. Myocardial infarction was more frequent with steroid administration [RR 1.17; 95% CI 1.07-1.38; P=0.008; I2=0%], and there was no significant difference in mortality [RR 0.87; 95% CI 0.70-1.07; P=0.14; I2=0%]. CONCLUSIONS: After analysing the data from RCTs of 12,999 patients, perioperative corticosteroid administration was found to significantly reduce the risk of postoperative infection and length of hospital stay, but increased the risk of myocardial infarction. More large trials need to be conducted in order to adequately assess the potential benefits of corticosteroid use in cardiac surgery.