Impact of intravenous steroids on subjective recovery quality after surgery: A meta-analysis of randomized clinical trials

Kuo-Chuan Hung; Li-Chen Chang; Chun-Ning Ho; Jheng-Yan Wu; Chih-Wei Hsu; Chien-Ming Lin; I-Wen Chen

doi:10.1016/j.jclinane.2024.111625

Impact of intravenous steroids on subjective recovery quality after surgery: A meta-analysis of randomized clinical trials

J Clin Anesth. 2024 Sep 17:99:111625. doi: 10.1016/j.jclinane.2024.111625. Online ahead of print.

Authors

Kuo-Chuan Hung¹, Li-Chen Chang², Chun-Ning Ho³, Jheng-Yan Wu⁴, Chih-Wei Hsu⁵, Chien-Ming Lin¹, I-Wen Chen⁶

Affiliations

¹ Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan.
² Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
³ Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁴ Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan.
⁵ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung city, Taiwan.
⁶ Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan city, Taiwan. Electronic address: cheniwena60912@gmail.com.

PMID: 39293148
DOI: 10.1016/j.jclinane.2024.111625

Abstract

Study objective: Quality of postoperative recovery is a crucial aspect of perioperative care. This meta-analysis aimed to evaluate the efficacy of intravenous steroids in improving the quality of recovery (QoR) after surgery, as measured by validated QoR scales.

Design: Meta-analysis of randomized controlled trials (RCTs).

Setting: Operating room.

Intervention: The use of a single dose of intravenous steroids as a supplement to general anesthesia.

Patients: Adult patients undergoing surgery.

Measurements: A literature search was conducted using electronic databases (e.g., MEDLINE and Embase) from their inception to June 2024. Randomized controlled trials (RCTs) comparing intravenous steroids with placebo or no treatment in adult patients undergoing surgery under general anesthesia were included. The primary outcome was the QoR scores on postoperative days (POD) 1 and 2-3, as assessed by validated QoR scales (QoR-15 and QoR-40). Secondary outcomes included QoR dimensions, analgesic rescue, pain scores, and postoperative nausea and vomiting (PONV).

Main results: Eleven RCTs involving 951 patients were included in this study. The steroid group showed significant improvements in global QoR scores on POD 1 (standardized mean difference [SMD]: 0.52; 95 % confidence interval[CI]: 0.22 to 0.82; P = 0.0007) and POD 2-3 (SMD: 0.50; 95 % CI: 0.19 to 0.81; P = 0.001) compared to the control group. Significant improvements were also observed in all QoR dimensions on POD 1, with the effect sizes ranging from small to moderate. Intravenous steroids also significantly reduced the analgesic rescue requirements (RR: 0.77; 95 % CI: 0.67 to 0.88; P = 0.0003), postoperative pain scores (SMD: -0.41; 95 % CI: -0.68 to -0.14; P = 0.003), and PONV incidence (RR: 0.73; 95 % CI: 0.56 to 0.95; P = 0.02).

Conclusions: Intravenous administration of steroids significantly improved QoR after surgery. The benefits of steroids extend to all dimensions of QoR and important clinical outcomes such as analgesic requirements, pain scores, and PONV. These findings support the use of steroids as an effective strategy to enhance the postoperative recovery quality.

Keywords: Dexamethasone; Pain score; Quality of recovery; Steroid.