PhD Scientific Days 2022

Clinical Medicine V. (Poster discussion will take place in the Aula during the Coffee Break)

Preoperative administration of glucocorticoids reduces the postoperative complication rate in liver surgery

Text of the abstract

Introduction
Liver surgery has complication rates of up to 48%. Alleviating the postoperative hyperinflammatory state with glucocorticoids (GC) may be beneficial. Evidence on the efficacy of this intervention however has been inconclusive thus far.

Aims
To perform a systematic review on the preoperative administration of GCs to assess the evidence about its efficacy in reducing overall postoperative complication rate (Cx%), and improving liver function recovery.

Methods
We performed a systematic literature search on Pubmed, Embase, and CENTRAL (PROSPERO registration: CRD42021284559). The target population was adult patients undergoing liver resections or transplantation, who were administered GC preoperatively. Our primary outcome was Cx%. The data was analyzed with META, DMETAR packages in R statistical software. A random-effects model was applied: for dichotomous variables pooled ORs, and for continuous outcomes pooled MDs with their 95% CI were calculated to investigate the differences between the compared arms.

Results
Our search yielded 11 eligible publications, which reported the use of preoperative GC administration on 964 patients. All studies included in our review were randomized controlled trials. All patients in the intervention groups (n=487) had been administered GC, either methylprednisolone (MP) or hydrocortisone (HC). Those receiving MP either received 500 mg of IV infusion before the surgery (n=197), 30 mg/kg (n=35), or received 10 mg/kg (n=105). Patients receiving HC received 500 mg infusion immediately before hepatic pedicle clamping, with 300 mg, 200 mg, and 100 mg on postoperative days 1, 2, and 3 respectively (n=150). Data pooled from 9 studies (n=837) revealed reduction of Cx% in the intervention group (OR=0.71, 95% CI= 0.38; 1.31). Out of 11 studies, 8 (n=777) reported a significant reduction in postoperative values of total bilirubin, 5 (n=379) in IL-6, and 5 (n=698) reported significant improvement in prothrombin time in the intervention group. No adverse events related to the intervention have been reported.

Conclusion
Preoperative administration of glucocorticoids was associated with lower postoperative complication rate and improved liver function recovery. Our results have identified the key points future clinical trials must investigate for a higher level of evidence.

Funding
There was no funding support for this study.