Peri‐operative steroid supplementation

Nicholson, Grainne; Burrin, J. M.; Hall, George

doi:10.1046/j.1365-2044.1998.00578.x

Cited by 141 publications

(78 citation statements)

References 129 publications

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“…However, the present meta-analysis along with prior randomised trials and meta-analyses have failed to demonstrate a significant increase in either complication in patients given corticosteroids [21,24,[53][54]. Much of the prior evidence regarding wound healing and infection has arisen from literature surrounding surgery for inflammatory bowel disease, in those undergoing transplant surgery, or in those with diseases of the hypothalamo-pituitaryadrenal axis [55]. Indeed, recent meta-analysis of both experimental and clinical trials suggests that receiving corticosteroids at standard therapeutic doses for 10 days or less is unlikely to impair wound healing [56].…”

Section: Discussionmentioning

confidence: 72%

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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. (2016) The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Critical Reviews in Oncology Hematology, 101, pp. 139-150. (doi:10.1016Hematology, 101, pp. 139-150. (doi:10. /j.critrevonc.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/117484/ This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. This meta-analysis examined the impact of preoperative corticosteroids on interleukin 6 (IL-6), C-reactive protein (CRP), and complications following surgery for gastrointestinal cancer. Methods:A systematic review was performed using appropriate keywords. Random-effects metaanalysis was performed.Results:11 RCTs with 474 patients, were included. Corticosteroids were significantly associated with lower IL-6 on postoperative day 1 (mean difference -148 pg/mL, 95% CI -205 to -92, p<0.001), 2 (-33 pg/mL, 95% CI -58 to -8, p=0.01), and 3 (-31 pg/mL, 95% CI -52 to -11, p=0.002), lower CRP on day 3 (-45 mg/L, 95% CI -68 to -21, p<0.001), and 7 (-14 mg/L, 95% CI -27 to -1, p=0.04), and fewer postoperative infective complications (OR 0.47, 95% CI 0.26 to 0.83, p=0.01).2 Conclusion:Corticosteroids were associated with reduction in the postoperative systemic inflammatory response and complications following surgery for gastrointestinal cancer.

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Section: Discussionmentioning

confidence: 72%

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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“…We should add, however, that such a cortisol increment is relatively modest compared with the increases that can be observed in individuals subjected to major physiological stressors such as trauma or anesthesia/surgery, where a 400-500% rise is not uncommon (45). It is difficult to say whether cortisol levels could rise this high in the financial world.…”

Section: Discussionmentioning

confidence: 93%

Cortisol shifts financial risk preferences

Kandasamy

Hardy

Page

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

209

137

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Risk taking is central to human activity. Consequently, it lies at the focal point of behavioral sciences such as neuroscience, economics, and finance. Many influential models from these sciences assume that financial risk preferences form a stable trait. Is this assumption justified and, if not, what causes the appetite for risk to fluctuate? We have previously found that traders experience a sustained increase in the stress hormone cortisol when the amount of uncertainty, in the form of market volatility, increases. Here we ask whether these elevated cortisol levels shift risk preferences. Using a double-blind, placebo-controlled, cross-over protocol we raised cortisol levels in volunteers over 8 d to the same extent previously observed in traders. We then tested for the utility and probability weighting functions underlying their risk taking and found that participants became more risk-averse. We also observed that the weighting of probabilities became more distorted among men relative to women. These results suggest that risk preferences are highly dynamic. Specifically, the stress response calibrates risk taking to our circumstances, reducing it in times of prolonged uncertainty, such as a financial crisis. Physiology-induced shifts in risk preferences may thus be an underappreciated cause of market instability.

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“…Much of the prior evidence regarding wound healing and infection has arisen from literature surrounding surgery for inflammatory bowel disease, in those undergoing transplant surgery, or in those with diseases of the hypothalamopituitary-adrenal axis [55]. Indeed, recent meta-analysis of both experimental and clinical trials suggests that receiving corticosteroids at standard therapeutic doses for 10 days or less is unlikely to impair wound healing [56].…”

Section: Discussionmentioning

confidence: 99%

The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis

McSorley

Horgan

McMillan

2016

Critical Reviews in Oncology/Hematology

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Highlights• Systematic review and meta-analysis of preoperative corticosteroids in surgery for GI cancers • Reports significant association between preoperative corticosteroids and lower postoperative IL-6 and CRP • The relationship between corticosteroids and lower postoperative systemic inflammatory response may underpin the impact on postoperative complications This meta-analysis examined the impact of preoperative corticosteroids on interleukin 6 (IL-6), C-reactive protein (CRP), and complications following surgery for gastrointestinal cancer. Keywords Methods:A systematic review was performed using appropriate keywords. Random-effects metaanalysis was performed.Results:11 RCTs with 474 patients, were included. Corticosteroids were significantly associated with lower IL-6 on postoperative day 1 (mean difference -148 pg/mL, 95% CI -205 to -92, p<0.001), 2 (-33 pg/mL, 95% CI -58 to -8, p=0.01), and 3 (-31 pg/mL, 95% CI -52 to -11, p=0.002), lower CRP on day 3 (-45 mg/L, 95% CI -68 to -21, p<0.001), and 7 (-14 mg/L, 95% CI -27 to -1, p=0.04), and fewer postoperative infective complications (OR 0.47, 95%CI 0.26 to 0.83, p=0.01). Conclusion:Corticosteroids were associated with reduction in the postoperative systemic inflammatory response and complications following surgery for gastrointestinal cancer.

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Peri‐operative steroid supplementation

Cited by 141 publications

References 129 publications

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: A systematic review and meta-analysis

Cortisol shifts financial risk preferences

The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis

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