Impact Of Preoperative Glucocorticoids On Postoperative Complications In General Surgery Based On Enhanced Recovery After Surgery

Aim: A meta-analysis was performed to evaluate the relationship between preoperative usage of glucocorticoids and postoperative complications in patients undergoing ERAS pathway.To investigate the applicability and safety of preoperative use of glucocorticoid in ERAS pathway.Method: We searched PUBMED ? EMBASE ? CENTRAL and CBM for literatures,which assess postoperative complications incidence or prevalence in preoperative glucocorticoids users versus nonusers that were published before September 2017.We used the Revman(version 5.3)software to calculate the odds ratios(OR),standardized mean difference(SMD)and 95% confidence interval(CI)for the risk of general surgery associated with exposure to preoperative glucocorticoid.We focused on the post-operative complications as the primary outcomes,which included total complications,wound infection,fistula and ileus.And the secondary outcomes included: the first anal exhaust time,the first defecation time and the length of stay.Result: There was no increase in the morbidity of digestive tract complications in patients receiving preoperative glucocorticoids on total complication [OR 0.60(95% CI: 0.44,0.83),P<0.05] and wound infection [OR 0.60(95% CI: 0.44,0.83),P<0.05].The incidence rate of fistula [OR 1.46(95% CI: 0.69,3.11),P > 0.05] and ileus [OR 0.36(95%CI: 0.08,1.62),P > 0.05] had no statistical significance increase.The secondary endpoints also showed that there was a significant decrease in patients receiving preoperative glucocorticoids at the first anal exhaust time [SMD-1.65(-3.39,0.09),P=0.06],defecating time [SMD-1.24(-2.54,0.06),P=0.06] and length of stay(LOS)[SMD-1.45(95% CI:-2.76,-0.15),P<0.05].Conclusion: Preoperative usage of glucocorticoids didn't increase the risk of postoperative complications in general surgery patients and should be considered as a routine procedure in Enhanced Recovery after Surgery protocol.