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

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-09-17 DOI:10.1016/j.jclinane.2024.111625

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引用次数: 0

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.

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静脉注射类固醇对术后主观恢复质量的影响：随机临床试验荟萃分析

研究目的术后恢复质量是围手术期护理的一个重要方面。这项荟萃分析旨在评估静脉注射类固醇在改善术后恢复质量（QoR）方面的疗效，并采用有效的 QoR 量表进行测量。设计荟萃分析随机对照试验（RCTs）.环境手术室.干预单剂量静脉注射类固醇作为全身麻醉的补充.患者接受手术的成人患者.测量使用电子数据库（如 MEDLINE 和 Embase）进行文献检索，检索时间从开始到 2024 年 6 月、MEDLINE和Embase）进行文献检索。纳入了对接受全身麻醉手术的成年患者进行静脉注射类固醇与安慰剂或无治疗进行比较的随机对照试验（RCT）。主要结果是术后第 1 天和第 2-3 天的 QoR 评分，由有效的 QoR 量表（QoR-15 和 QoR-40）进行评估。次要结果包括 QoR 维度、镇痛抢救、疼痛评分以及术后恶心和呕吐 (PONV)。类固醇组在 POD 1 的总体 QoR 评分上有明显改善（标准化平均差 [SMD]：0.52；95 % 置信区间：0.52；95 % 置信区间：0.52）：0.52; 95 % 置信区间[CI]：P = 0.0007）和 POD 2-3 （SMD：0.50；95 % 置信区间[CI]：0.19 至 0.81；P = 0.001）。在 POD 1 的所有 QoR 维度上也观察到了显著改善，效应大小从小幅到中度不等。静脉注射类固醇还显著降低了镇痛抢救需求（RR：0.77；95 % CI：0.67 至 0.88；P = 0.0003）、术后疼痛评分（SMD：-0.41；95 % CI：-0.68 至 -0.14；P = 0.003）和 PONV 发生率（RR：0.73；95 % CI：0.56 至 0.95；P = 0.02）。类固醇的益处延伸至QoR的所有方面以及重要的临床结果，如镇痛剂需求、疼痛评分和PONV。这些研究结果支持使用类固醇作为提高术后恢复质量的有效策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.