Impact of perioperative steroid administration in patients undergoing elective liver resection: Meta-analysis
Open accessAbstract
Background: Perioperative steroid administration may improve postoperative outcomes in major abdominal surgery by reducing the systemic inflammatory response. The aim of this systematic review was to evaluate the impact of perioperative steroid administration on outcomes after elective liver resection. Methods: PubMed, Cochrane Library, and Web of Science were systematically searched for randomized clinical trials (RCTs) comparing perioperative steroid administration with placebo, standard of care, or no steroids with respect to postoperative outcomes, particularly postoperative complications. Two independent reviewers critically appraised the studies and extracted data. Meta-analyses were performed using a random-effects model with ORs calculated for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Results: Ten RCTs comprising 930 patients were included. Perioperative steroid administration significantly reduced the overall postoperative complication rate (OR 0.61, 95 per cent c.i. 0.43 to 0.87; P = 0.006; I2 = 26 per cent). No significant differences were shown for individual complications. Several postoperative laboratory parameters were positively affected, like total serum bilirubin (MD −0.46; 95 per cent c.i. −0.74 to −0.18; P = 0.001; I2 = 80 per cent), interleukin 6 (MD −48.99; 95 per cent c.i. −60.72 to −37.27; P < 0.001; I2 = 0 per cent) and C-reactive protein (MD −5.20; 95 per cent c.i. −7.62 to −2.77; P < 0.001; I2 = 71 per cent). There were no signs of an increase in potential steroid-induced adverse events, namely infectious complications, thromboembolic events, or bleeding. Conclusions: Perioperative steroid administration significantly reduces the overall complication rate after elective liver resection without an increased risk of adverse effects.
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Most publications are underpowered to assess CR-PHLF with event rates of 5-15%, with commonly less than 50 patients included per study.
“With commonly less than 50 patients included per study, most publications are underpowered to assess CR-PHLF with event rates of 5–15% according to the literature [5,7,13,38,39].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [38]
The Discussion (page not available) says statistical power for PHLF was limited because only seven of ten trials reported it, supporting the concern about power. It does not give a 5–15% CR-PHLF event rate, and Table 1 (Results; page not available) does not support the claim that studies commonly included fewer than 50 patients in total. (LLM, conf=0.88)
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- Authors
- Jötten, L., Steinkraus, K. C., Traub, B., Graf, S., Mihaljevic, A. L., Kornmann, M., Michalski, C. W., & Hüttner, F. J.
- Affiliations
- University Hospital Ulm (DE)
- Department of General and Visceral Surgery, Ulm University Hospital , Ulm , Germany
- Corresponding author
- Hüttner, Felix J
- Venue
- BJS Open
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-11-02
- Volume
- 6
- Issue
- 6
- ISSN
- 2474-9842 (ISSN-L)
- PMC
- PMC9764439
- OpenAlex
- W4312081927
- Cited by
- 10
- References
- 65
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 3
- FWCI
- 0.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BJS Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- OPen Access Repositorium der Universität Ulm (OPARU) (Ulm University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- perioperative corticosteroids, hepatectomy, postoperative complications, systemic inflammatory response, interleukin-6, C-reactive protein, serum bilirubin, corticosteroid adverse effects, elective abdominal surgery
- MeSH terms
- Hepatectomy, Humans, Liver, Postoperative Complications
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