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Drug Safety

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01-11-2000 | Original Research Article

Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients

A Systematic Review

Authors: Stefan Sauerland, Manfred Nagelschmidt, Peter Mallmann, Professor Edmund A. M. Neugebauer

Published in: Drug Safety | Issue 5/2000

Abstract

Background: A single preoperative high dose of methylprednisolone (15 to 30 mg/kg) has been advocated in surgery, because it may inhibit the surgical stress response and thereby improve postoperative outcome and convalescence. However, these potential clinical benefits must be weighed against possible adverse effects.

Objective: To conduct a risk-benefit analysis using a meta-analysis, to compare complication rates and clinical advantages associated with the use of high dose methylprednisolone in surgical patients.

Methods: Randomised controlled trials of high dose methylprednisolone in elective and trauma surgery were systematically searched for in various literature databases. Outcome data on adverse effects, postoperative pain and hospital stay were extracted and statistically pooled in fixed-effects meta-analyses.

Results: We located 51 studies in elective cardiac and noncardiac surgery, aswell as traumatology. Pooled data failed to show any significant increase in complication rates. In patients treated with corticosteroids, nonsignificantly more gastrointestinal bleeding and wound complications were observed; the 95% confidence interval boundaries of the numbers-needed-to-harm were 59 and 38, respectively. The only significant finding was a reduction of pulmonary complications (risk difference −3.5%; 95% confidence interval −1.0 to −6.1), mainly in trauma patients.

Conclusion: For patients undergoing surgical procedures, a perioperative single-shot administration of high dose methylprednisolone is not associated with a significant increase in the incidence of adverse effects. In patients with multiple fractures, limited evidence suggests promising benefits of glucocorticoids on pulmonary complications.

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Title: Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients
A Systematic Review
Authors: Stefan Sauerland
Manfred Nagelschmidt
Peter Mallmann
Professor Edmund A. M. Neugebauer
Publication date: 01-11-2000
Publisher: Springer International Publishing
Published in: Drug Safety / Issue 5/2000
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI: https://doi.org/10.2165/00002018-200023050-00007

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients

A Systematic Review

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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