Prophylactic Role of Perioperative Corticosteroids for Postoperative Neurocognitive Dysfunction- metaanalysis

Recent research paper titled "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" aimed to evaluate the prophylactic role of perioperative corticosteroids for postoperative neurocognitive dysfunction (PNCD) in adult surgical patients. The systematic review and meta‑analysis included 15 randomized controlled trials (RCTs) comprising 15,398 patients. The primary outcome assessed was the incidence of PNCD within 1 month, while secondary outcomes included the use of antipsychotic medications for treatment, postoperative infection, and hospital length of stay.

Findings and Conclusions

The findings from the meta-analysis revealed that the incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled odds ratio of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). The results of the trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD, though the requisite information size was considered inadequate. Subgroup analysis supported the prophylactic effect of corticosteroids on delirium prevention, but not on delayed neurocognitive recovery. The meta-analysis concluded that corticosteroids demonstrated statistically significant protective effects on the incidence of PNCD. However, the researchers emphasized the need for further studies to confirm the protective role of corticosteroids for preventing PNCD.

Study Limitations and Recommendations

The paper provided detailed information on the methods used for the systematic review and meta-analysis, the specific outcomes measured, the results obtained from the analysis, and the conclusions drawn based on the findings. The researchers also discussed the limitations of the study, including clinical heterogeneity in outcomes, the lack of standardized screening criteria, and the limited evidence from RCTs targeting high-risk patients. Additionally, the paper emphasized the need for bundled approaches targeting multiple pathways of neurological injury during the perioperative period to effectively prevent PNCD in high-risk patient populations. Overall, the paper provided comprehensive insights into the potential prophylactic role of corticosteroids in preventing PNCD in adult surgical patients.

Key Points

1. The research paper conducted a systematic review and meta-analysis of 15 randomized controlled trials involving 15,398 adult surgical patients to evaluate the prophylactic role of perioperative corticosteroids for preventing postoperative neurocognitive dysfunction (PNCD). The primary outcome assessed was the incidence of PNCD within 1 month post-surgery, and secondary outcomes included the use of antipsychotic medications for treatment, postoperative infection, and hospital length of stay.

2. The findings from the meta-analysis indicated that the incidence of PNCD was significantly lower in the corticosteroid group compared to the control group, with a pooled odds ratio of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). The trial sequential analysis also supported the clinical benefit of corticosteroids in preventing PNCD, although the requisite information size was considered inadequate. Subgroup analysis demonstrated the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery. The researchers concluded that corticosteroids showed statistically significant protective effects on the incidence of PNCD, but they emphasized the need for further studies to confirm their role in preventing PNCD.

3. The study discussed various limitations, including clinical heterogeneity in outcomes, the lack of standardized screening criteria, and the limited evidence targeting high-risk patients. The researchers recommended the need for bundled approaches targeting multiple pathways of neurological injury during the perioperative period to effectively prevent PNCD in high-risk patient populations. Overall, the paper provided comprehensive insights into the potential prophylactic role of corticosteroids in preventing PNCD in adult surgical patients.

Reference –

Singh NP, Makkar JK, Goel N, Karamchandani K, Singh M, Singh PM. 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. Indian J Anaesth 2024;68:517-26.