Effects of Glucocorticoids on Postoperative Neurocognitive Disorders in Adult Patients: A Systematic Review and Meta-Analysis

Abstract

BackgroundPostoperative neurocognitive disorders (PNDs) is common among surgical patients, however, the effect of glucocorticoids for preventing PNDs is not clear. This review aims to evaluate the effect of glucocorticoids on the incidence of PNDs in adult patients undergoing surgery.MethodsThe databases of PubMed/Medline, Embase, the Cochrane Library, and Web of science were searched for all available randomized controlled trials (RCTs) from inception to April 30, 2022. RCTs comparing the effect of glucocorticoids with placebo on the incidence of PNDs in adult surgical patients (≥18 years old) were eligible. Subgroup analyses and meta-regressions were performed to evaluate sources of clinical heterogeneity. The level of certainty for main outcomes were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.ResultsEleven trials with a total of 10,703 patients were identified. Compared with the control group, glucocorticoids did not reduce the incidence of PNDs (RR: 0.84, 95% CI: 0.67 to 1.06, P = 0.13, GRADE = moderate). Secondary analyses for primary outcome did not change the result. In addition, the length of ICU stay was decreased in glucocorticoids group (RR: −13.58, 95% CI: −26.37 to −0.80, P = 0.04, GRADE = low). However, there were no significant differences between groups with regards to the incidence of postoperative infection (RR: 0.94, 95% CI: 0.84 to 1.06, P = 0.30, GRADE = moderate), blood glucose level (RR: 1.05, 95% CI: −0.09 to 2.19, P = 0.07, GRADE = low), duration of mechanical ventilation (RR: −2.44, 95% CI: −5.47 to 0.59, P = 0.14, GRADE = low), length of hospital stay (RR: −0.09, 95% CI: −0.27 to 0.09, P = 0.33, GRADE = moderate) and 30-day mortality (RR: 0.86, 95% CI: 0.70 to 1.06, P = 0.16, GRADE = moderate).ConclusionsThis meta-analysis suggests that perioperative administration of glucocorticoids may not reduce the incidence of PNDs after surgery. The effect of glucocorticoids on decreased length of ICU stay needs further researches. Future high-quality trials using acknowledged criteria and validated diagnostic tools are needed to determine the influence of glucocorticoids on long-term PNDs.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302262, identifier: CRD42022302262.

Effect of prophylactic corticosteroids on postoperative neurocognitive dysfunction in the adult population: An updated systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials

“…A recent meta-analysis conducted to determine the prophylactic efficacy of steroids in PNCD patients concluded that there was no significant difference compared with that of the control group. [ 13 ] The lack of benefit on PNCD with corticosteroids seen in this meta-analysis could be attributed to the relatively small number of included patients compared to our sample size. The TSA of our meta-analysis also revealed that more RCTs are still required to reach any definite conclusions.…”

“…[ 12 ] In a recently published meta-analysis, Xie et al . [ 13 ] delineated no benefit of adding corticosteroids to postoperative delirium; however, the authors did not calculate the requisite sample size to draw definite conclusions. The sample size of the meta-analysis increases by including more randomised controlled trials (RCTs), leading to greater precision in estimating the effect size or association between variables, which may lead to more reliable conclusions.…”

Early postoperative cognitive decline—are there any preventive strategies for surgical patients in the emergency setting?

“…As for the effects of the potent anti-inflammatory dexamethasone on incidence of postoperative neurocognitive decline, the current reports are highly variable, with encouraging results only in animal models [1,4]. A randomized clinical trial of patients receiving dexamethasone intraoperative failed to demonstrate a benefit in both early and late cognitive decline following surgery [34].…”