Perioperative Corticosteroids In Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis

Article Impact Level: HIGH
Data Quality: STRONG
Summary of Clinical Cardiology, clc.24018. https://doi.org/10.1002/clc.24018
Dr. Daliu Chen et al.

Points

• The use of perioperative corticosteroids in pediatric cardiac surgery with CPB is still controversial.
• A systematic review and meta-analysis of ten randomized controlled trials with 7,798 pediatric participants aged 0-18 were conducted to investigate the impact of corticosteroids on postoperative mortality and clinical outcomes.
• The study found that the corticosteroid group had no significant difference in all-cause in-hospital mortality but had a significantly shorter hospital stay than the placebo group.
• The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the studies.
• The authors recommend conducting more randomized controlled studies with larger samples to draw more definitive conclusions and establish the efficacy of perioperative corticosteroids.

Summary

The use of perioperative corticosteroids in pediatric cardiac surgery with cardiopulmonary bypass (CPB) is still controversial. To investigate the impact of corticosteroids on postoperative mortality and clinical outcomes, this study conducted a systematic review and meta-analysis of randomized controlled trials. A comprehensive search was conducted using the MEDLINE, EMBASE, and Cochrane databases up to January 2023. The meta-analysis included ten trials and 7,798 pediatric participants aged 0-18 who underwent cardiac surgery and received either corticosteroids or other therapeutic interventions, placebo, or no treatment. The primary endpoint was all-cause hospital mortality, and the secondary endpoint was the duration of hospitalization.

The study results revealed no significant difference in all-cause in-hospital mortality between the corticosteroid and other treatment groups. The random-effect model showed that the relative risk (RR) was 0.38 (95% confidence interval [CI] = 0.16-0.91, I² = 79%, p = 0.03) for methylprednisolone and 0.29 (95% CI = 0.09-0.97, I² = 80%, p = 0.04) for dexamethasone. However, the corticosteroid group had a significantly shorter hospital stay than the placebo group. The pooled standard mean difference (SMD) was -0.86 (95% CI = -1.57 to -0.15, I² = 85%, p = 0.02) for methylprednisolone and -0.97 (95% CI = -1.90 to -0.04, I² = 83%, p = 0.04) for dexamethasone. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the studies.

The study’s authors suggest that perioperative corticosteroids may not enhance all-cause mortality outcomes in pediatric cardiac surgery with CPB but may reduce hospital stay compared to placebo. Nevertheless, they recommend that more randomized controlled studies with larger samples be conducted to draw more definitive conclusions. In conclusion, this study provides insight into the potential benefits and drawbacks of using corticosteroids in pediatric cardiac surgery with CPB, emphasizing the need for further research to establish the efficacy of perioperative corticosteroids.

Link to the article: https://onlinelibrary.wiley.com/doi/full/10.1002/clc.24018

References

Chen, D., & Du, Y. (2023). Analysis of perioperative corticosteroid therapy in children undergoing cardiac surgery: A systematic review and meta‐analysis. Clinical Cardiology, clc.24018. https://doi.org/10.1002/clc.24018