SRS207 - The role of pre-operative systemic corticosteroids in functional endoscopic sinus surgery: a systematic review and meta-analysis

Abstract Introduction Functional Endoscopic Sinus Surgery (FESS) is widely used to improve symptoms and quality of life for patients with Chronic Rhinosinusitis. Many centres prepare patients for FESS using preoperative corticosteroids to improve surgical field visibility (SFV) and reduce total intraoperative blood loss (TBL). However, this also confers a significant risk of side effects, including insomnia, mood disorders, weight gain, gastric irritation and osteoporosis. We sought to evaluate the efficacy of this approach with regard to intraoperative and postoperative surgical outcomes through a systematic review and meta-analysis. Methods This review was prospectively registered with PROSPERO (CRD42023412361) and adhered to PRISMA reporting guidelines. Systematic searches of MEDLINE, CENTRAL and EMBASE in March 2025 identified studies comparing preoperative systemic corticosteroids to placebo in patients undergoing FESS. Random-effects meta-analyses were conducted to generate restricted maximum-likelihood estimates for the TBL, SFV, and preoperative Lund-Mackay scores in the treatment and placebo cohorts. Study quality was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias. Results The systematic search identified 3047 unique papers; 10 eligible papers, comprising 761 patients, were included in our final analyses. Meta-analysis revealed no significant difference between the TBL, SFV, duration of surgery, or pre-operative Lund-Mackay scores in patients treated with pre-operative corticosteroids compared to controls (P < .05 for each). Conclusions Further randomised controlled trials need to be conducted to determine the benefit of systemic corticosteroids before FESS. Given the side effects associated with systemic, but not topical, corticosteroids, we encourage clinicians to critically evaluate the route of corticosteroid administration before FESS.