Impact of Preoperative Steroids Administration on Endoscopic Sinus Surgery: Systematic Review of Literature, and a Survey in Saudi Arabia

There is limited knowledge in the literature and lack of clear protocols among practitioners regarding preoperative steroids administration for patients undergoing endoscopic sinus surgery (ESS). This study aimed to identify the practice patterns of rhinologists in Saudi Arabia as well as systematically review all health-related evidence regarding the use of preoperative steroids for ESS. A previously used questionnaire was modified and distributed in Saudi Arabia among rhinologists who finished their residency training. It entailed questions about their qualifications and preoperative steroids use, preferred regimen, and possible benefits. Also, a systematic literature review using four major databases was conducted to build a scoping view of the current evidence. A total of 94 subjects responded to the mailed survey. Of them, 72(76.6%) used preoperative steroids; 40 subjects believed that there is a strong supporting evidence while 32 reported that there is no solid evidence. The commonest indication was chronic rhinosinusitis with nasal polyp followed by allergic fungal rhinosinusitis. More than half of subjects (54.2%) preferred medium-dose prednisone (30–40 mg/day). A considerable number believed that steroids decreased surgical bleeding (n = 57, 79.2%), improved surgical field visualization (77.8%), decreased surgical time (77.8%), and decreased mucosal inflammation (61.1%). Thirteen studies including 1028 patients were eligible for the systematic review. Only three studies reported a statistically significant effect of steroids in reducing intraoperative hemorrhage, while only two studies revealed that steroids significantly improved surgical field quality. In two studies, steroids showed a significant effect in reducing eosinophil infiltration. There is a major number of rhinology experts using preoperative steroids for patients undergoing ESS but there is a wide variation among their practice patterns. The current potential advantages of steroids need to be supported by further large randomized clinical trials to establish clear guidelines.