Christopher J Coroneos1, Sophocles H Voineskos1, Deborah J Cook1, Forough Farrokyar1, Achilleas Thoma1. 1. Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal.
Abstract
BACKGROUND: A number of randomized controlled trials (RCTs) have investigated the role of perioperative corticosteroids in rhinoplasty. Each of these trials however has an insufficient sample sizes to reach definitive conclusions and detect harms. Three recent reviews have analyzed edema and ecchymosis outcomes following rhinoplasty; each arrived at a different conclusion and recommendation. OBJECTIVE: To estimate the effectiveness of systemic perioperative corticosteroid treatment compared to placebo for clinical outcomes in rhinoplasty using a methodologically rigorous meta-analysis. METHODS: Electronic databases were searched without language restriction. Included trials were randomized controlled trials of systemic perioperative corticosteroid treatment vs placebo in rhinoplasty evaluating at least one of: edema, ecchymosis, bleeding, cosmetic outcome, and patient satisfaction. The Cochrane risk of bias tool was applied to included trials, and the quality of evidence for each outcome was assessed using the GRADE approach. RESULTS: Analyses included 336 patients from eight trials. Perioperative corticosteroids reduced the worst edema (SMD: -1.03, 95%CI -1.30 to -0.76, P < .001) and ecchymosis (SMD: -0.78, 95%CI -1.09 to 0.47, P < .001) after rhinoplasty. At one day postoperative, a single dose of perioperative corticosteroid reduced edema (SMD -1.15, 95%CI -1.42 to -0.87, P < .001) and ecchymosis (SMD -0.79, 95%CI -1.05 to -0.52, P < .001). No clinical benefit in edema or ecchymosis was found seven days postoperatively, nor did intraoperative bleeding increase. CONCLUSIONS: There is high quality evidence to support perioperative systemic corticosteroid treatment in rhinoplasty to reduce short-term edema and ecchymosis without increased intraoperative bleeding. These findings are not present at seven days. For future trials, we suggest evaluation of patient satisfaction, and correlation with long-term cosmetic outcome. LEVEL OF EVIDENCE 2: Therapeutic.
BACKGROUND: A number of randomized controlled trials (RCTs) have investigated the role of perioperative corticosteroids in rhinoplasty. Each of these trials however has an insufficient sample sizes to reach definitive conclusions and detect harms. Three recent reviews have analyzed edema and ecchymosis outcomes following rhinoplasty; each arrived at a different conclusion and recommendation. OBJECTIVE: To estimate the effectiveness of systemic perioperative corticosteroid treatment compared to placebo for clinical outcomes in rhinoplasty using a methodologically rigorous meta-analysis. METHODS: Electronic databases were searched without language restriction. Included trials were randomized controlled trials of systemic perioperative corticosteroid treatment vs placebo in rhinoplasty evaluating at least one of: edema, ecchymosis, bleeding, cosmetic outcome, and patient satisfaction. The Cochrane risk of bias tool was applied to included trials, and the quality of evidence for each outcome was assessed using the GRADE approach. RESULTS: Analyses included 336 patients from eight trials. Perioperative corticosteroids reduced the worst edema (SMD: -1.03, 95%CI -1.30 to -0.76, P < .001) and ecchymosis (SMD: -0.78, 95%CI -1.09 to 0.47, P < .001) after rhinoplasty. At one day postoperative, a single dose of perioperative corticosteroid reduced edema (SMD -1.15, 95%CI -1.42 to -0.87, P < .001) and ecchymosis (SMD -0.79, 95%CI -1.05 to -0.52, P < .001). No clinical benefit in edema or ecchymosis was found seven days postoperatively, nor did intraoperative bleeding increase. CONCLUSIONS: There is high quality evidence to support perioperative systemic corticosteroid treatment in rhinoplasty to reduce short-term edema and ecchymosis without increased intraoperative bleeding. These findings are not present at seven days. For future trials, we suggest evaluation of patient satisfaction, and correlation with long-term cosmetic outcome. LEVEL OF EVIDENCE 2: Therapeutic.
Authors: Elie A Akl; Xin Sun; Jason W Busse; Bradley C Johnston; Matthias Briel; Sohail Mulla; John J You; Dirk Bassler; Francois Lamontagne; Claudio Vera; Mohamad Alshurafa; Christina M Katsios; Diane Heels-Ansdell; Qi Zhou; Ed Mills; Gordon H Guyatt Journal: J Clin Epidemiol Date: 2011-12-24 Impact factor: 6.437
Authors: P J Devereaux; Peter T-L Choi; Samer El-Dika; Mohit Bhandari; Victor M Montori; Holger J Schünemann; Amit X Garg; Jason W Busse; Diane Heels-Ansdell; William A Ghali; Braden J Manns; Gordon H Guyatt Journal: J Clin Epidemiol Date: 2004-12 Impact factor: 6.437
Authors: Gordon H Guyatt; Andrew D Oxman; Victor Montori; Gunn Vist; Regina Kunz; Jan Brozek; Pablo Alonso-Coello; Ben Djulbegovic; David Atkins; Yngve Falck-Ytter; John W Williams; Joerg Meerpohl; Susan L Norris; Elie A Akl; Holger J Schünemann Journal: J Clin Epidemiol Date: 2011-07-30 Impact factor: 6.437