Simon Jean1, Pierre-Luc Dionne2, Carl Bouchard3, Luc Giasson4, Alexis F Turgeon5. 1. Resident in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, Québec City, QC, Canada. Electronic address: simon.jean.4@ulaval.ca. 2. Resident in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, CHU de Québec-Université Laval, Québec City, QC, Canada. 3. Associate Professor, Department of Oral and Maxillofacial Surgery, CHU de Québec-Université Laval, Québec City, QC, Canada. 4. Associate Professor, Faculty of Dentistry, Université Laval, Québec City, QC, Canada. 5. Associate Professor and Research Director, Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City; Associate Director, Population Health and Optimal Health Practice Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Center, CHU de Québec-Université Laval, Québec City; Canadian Institutes of Health Research New Investigator and Scientific Director, Cochrane Canada Francophone, CHU de Québec-Université Laval, Québec City, QC, Canada.
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 have been raised. The purpose of this systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically important outcomes in patients undergoing orthognathic surgery. MATERIALS AND METHODS: The authors conducted a systematic review of randomized controlled trials evaluating the effect of systemic corticosteroids in orthognathic surgery compared with placebo or any other intervention. The authors searched Medline, Embase, Cochrane Central, CINAHL, Lilacs, Scopus, and Web of Science and references of included trials. The primary outcome was the incidence of postoperative reintubation during the index hospitalization. The secondary outcomes were hospital length of stay, decreases in facial edema, and adverse events. Data were summarized using Mantel-Haenszel random-effects models. RESULTS: Of the 1,098 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. There was a decrease in facial edema with the use of systemic corticosteroids (n = 80; standardized mean difference, -1.07; 95% confidence interval, -1.99 to -0.16; I2 = 67%). Three trials reported side effects, such as postoperative surgical site bleeding, hypersensitivity, and stomach discomfort with intake of corticosteroids. The 8 trials had an unclear risk of bias. CONCLUSION: The authors observed no evidence of effect of systemic corticosteroids on the risk of reintubation and hospital length of stay in orthognathic surgery. Although facial edema decrease was observed to be improved with the intervention, adverse effects were inconsistently screened and reported. Thus, the use of systemic steroids in orthognathic surgery is not supported by strong evidence.
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 have been raised. The purpose of this systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically important outcomes in patients undergoing orthognathic surgery. MATERIALS AND METHODS: The authors conducted a systematic review of randomized controlled trials evaluating the effect of systemic corticosteroids in orthognathic surgery compared with placebo or any other intervention. The authors searched Medline, Embase, Cochrane Central, CINAHL, Lilacs, Scopus, and Web of Science and references of included trials. The primary outcome was the incidence of postoperative reintubation during the index hospitalization. The secondary outcomes were hospital length of stay, decreases in facial edema, and adverse events. Data were summarized using Mantel-Haenszel random-effects models. RESULTS: Of the 1,098 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. There was a decrease in facial edema with the use of systemic corticosteroids (n = 80; standardized mean difference, -1.07; 95% confidence interval, -1.99 to -0.16; I2 = 67%). Three trials reported side effects, such as postoperative surgical site bleeding, hypersensitivity, and stomach discomfort with intake of corticosteroids. The 8 trials had an unclear risk of bias. CONCLUSION: The authors observed no evidence of effect of systemic corticosteroids on the risk of reintubation and hospital length of stay in orthognathic surgery. Although facial edema decrease was observed to be improved with the intervention, adverse effects were inconsistently screened and reported. Thus, the use of systemic steroids in orthognathic surgery is not supported by strong evidence.
Authors: Mariana González-Morelos; Lorenzo Franco-de la Torre; Diana Laura Franco-González; Eduardo Gómez-Sánchez; Ángel Josabad Alonso-Castro; Nelly Molina-Frechero; Luis Miguel Anaya-Esparza; Mario Alberto Isiordia-Espinoza Journal: Healthcare (Basel) Date: 2022-06-01