NEW YORK (Reuters Health) – In patients undergoing major abdominal surgery, pretreatment with a glucocorticoid decreases complications and time spent in the hospital, probably by attenuating the postsurgical inflammatory stress response.

That’s according to results of a systematic review and meta-analysis of relevant studies, which was published online June 20 ahead of print in the Annals of Surgery.

The paper’s first author is Dr. Sanket Srinivasa, a research fellow in the department of surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, New Zealand.

“The evidence suggests glucocorticoids are probably safe in major abdominal surgery but evidence remains a little thin in terms of overall patient numbers,” Dr. Srinivasa wrote in an email to Reuters Health.

Nonetheless, Dr. Srinivasa said, “the evidence that we now have gives us no reason to not use them to improve short term recovery and their clinical benefits seem real.”

In their paper, the investigators note that previous randomized controlled trials (RCTs) in major abdominal surgery have generated mixed results regarding the short-term benefits of preoperative glucocorticoid administration. “Importantly, the safety of this intervention has not been conclusively determined,” they say.

In a meta-analytic review of 11 relevant randomized controlled trials involving a total of 439 patients having major abdominal surgery, Dr. Srinivasa and colleagues found that preoperative glucocorticoid use significantly decreased overall complications (odds ratio [OR] 0.37; P < 0.01), with minimal heterogeneity in the results. Pretreatment also decreased infectious complications (OR = 0.35; P < 0.01), with no heterogeneity in the results.

Preoperative glucocorticoid use also reduced length of hospital stay by 2 days on average (P = 0.01), albeit with high levels of heterogeneity. Treatment also reduced serum levels of the proinflammatory cytokine interleukin-6 (IL-6) on postoperative day 1 by a mean of 55 pg/mL (P < 0.01), but again with high heterogeneity in studies.

In subset analyses, preoperative glucocorticoid use significantly decreased complications in liver resection (OR = 0.28) and mean length of stay by more than 2 days. It also tended to reduce complications in colorectal surgery (OR = 0.45) and reduced mean length of hospital stay by about 1 day.

Glucocorticoids did not appear to increase the risk of anastomotic leaks in colorectal surgery, the investigators report. However, due to the small number of patients, the influence of glucocorticoids on anastomotic leaks cannot be definitively stated, they say.

Overall, the results of this meta-analysis show that preoperative treatment with glucocorticoids improves short-term outcomes after major abdominal surgery.

They think this strategy “should be considered as a routine measure in suitable patients while evaluating long-term outcomes prospectively.”

But the authors of a linked commentary urge caution in adopting this policy, based on this meta-analysis.

In the article, Dr. Robert Udelsman and Maria Ciarleglio from Yale University School of Medicine in New Haven, Connecticut, say preoperative glucocorticoid use is “an important area of interest” and they applaud the researchers for attempting to employ meta-analysis to evaluate the data.

However, they say the results of this meta-analysis are constrained by the studies employed, the small total patient sample and the different types and doses of glucocorticoids used in the studies.

The results of this meta-analysis “do not seem to justify a major change in clinical care,” the authors say.

Dr. Udelsman and Dr. Ciarleglio also remind readers that elevated glucocorticoids are associated with “significant detrimental effects including hyperglycemia, impaired wound healing and an increased propensity to infection.”

Ann Surg 2011.