Perioperative systemic corticosteroids in orthognathic surgery : a systematic review and meta-analysis

Authors: Jean, SimonDionne, Pierre-LucBouchard, CarlGiasson, LucTurgeon-Fournier, Alexis
Abstract: Purpose: Perioperative systemic corticosteroids are broadly used in orthognathic surgery to prevent postoperative complications, but it is unclear whether this practice is beneficial and concerns about potential side effects were raised. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing orthognathic surgery. Methods: We conducted a systematic review of randomized controlled trials evaluating the effect of systemic corticosteroids in orthognathic surgery compared to placebo or any other intervention. We searched Medline, Embase, Cochrane Central, CINAHL, Lilacs, Scopus, and Web of science as well as references of included trials. Our primary outcome was the incidence of postoperative reintubation during the index hospitalization. Our secondary outcomes were hospital length of stay, facial edema reduction, and adverse events. We summarized data using Mantel-Haenszel random effect models. Results: Of the 1098 trials retrieved, 8 were included (n=234). No trial evaluated the risk of postoperative reintubation. One trial evaluated the duration of hospital stay and showed no difference associated with the intervention. We observed a decreased in facial edema with the use of systemic corticosteroids (n=80, SMD -1.07, [-1.99, -0.16], I2=67%). Three trials reported side effects such as postoperative surgical site bleeding, hypersensitivity, and stomach discomfort with corticosteroids intake. The eight trials had an unclear risk of bias. Conclusion We observed no evidence of effect of systemic corticosteroids on the risk of reintubation and hospital length of stay in orthognathic surgery. Although facial edema reduction was observed to be improved with the intervention, adverse effects were inconsistently screened and reported. The use of systemic steroids in orthognathic surgery is thus not supported by strong evidence.
Document Type: Article de recherche
Issue Date: 24 June 2017
Open Access Date: 16 May 2019
This document was published in: Journal of oral and maxillofacial surgery, Vol. 75 (12), 2638-2649 (2017)
W.B. Saunders Co.
Alternative version: 10.1016/j.joms.2017.06.014
Collection:Articles publiés dans des revues avec comité de lecture

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