Prophylactic Use of Glucocorticoids and Postoperative Delirium/Cognitive Dysfunction in Adults After Major Surgery: a Meta-Analysis of Randomized Controlled Trials

Abstract

Objectives. To investigate whether prophylactic use of glucocorticoids (GCs) would affect the incidence of postoperative delirium (POD)/cognitive dysfunction (POCD) after major surgeries. Methods. A systemic review of randomized controlled trials (RCTs) searched from the Pubmed, Cochrane Library, Embase, and Clinical Trials.gov was conducted. Effect of GCs on the incidence of POD/POCD and several secondary outcomes, including s100-β, mechanical ventilation time, length of ICU stay, length of postoperative hospital stay, postoperative cardiac arrhythmia, and adverse outcomes, were analyzed. The Cochrane Collaboration’s risk of bias tool and the GRADE system were used to assess the risk of bias of included studies and the evidence quality of combined results, respectively. Results. There were 726 records detected and only 11 studies were included at last. Six of the 11 RCT studies were categorized as low risk of bias, 3 studies as unclear, and 2 as high. Prophylactic use of GCs didn’t show any significant effect on the incidence of POD/POCD after major surgeries, but the evidence quality of this result was very low. For the secondary outcome, GCs can significantly decrease the level of s100-β, length of ICU stay, length of postoperative hospital stay, and ventilation time, with the evidence quality varied from very low to moderate. For the rest of the secondary outcomes, no significant effect was observed. Conclusion. Prophylactic use of GCs didn’t have a significant effect on the incidence of POD and POCD. However, this result was very uncertain, and more relevant high-quality RCTs are needed.