Single-dose Preoperative Glucocorticoids in Major Gastrointestinal Surgery

OBJECTIVE: To evaluate the clinical efficacy and safety of single-dose preoperative systemic glucocorticoids in adults undergoing major gastrointestinal surgery. SUMMARY OF BACKGROUND DATA: Major gastrointestinal surgery induces a systemic inflammatory response that contributes to postoperative morbidity and delayed recovery. Single-dose glucocorticoids attenuate inflammation, but uncertainty remains regarding clinical benefit, safety, and optimal dosing. METHODS: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials was performed and registered with PROSPERO. Trials comparing a single preoperative systemic glucocorticoid with placebo or no steroid in adult major gastrointestinal surgery were included. Primary outcomes were total postoperative complications and infectious complications. Secondary outcomes included length of stay, anastomotic leak, postoperative day 1 inflammatory markers, and mortality. Random-effects models were used. Dose-stratified analyses were prespecified and exploratory. RESULTS: Eighteen randomized trials, including 3667 patients were analyzed. Preoperative glucocorticoids reduced total postoperative complications (OR 0.69, 95% CI: 0.54-0.89; I²=12%) and infectious complications (OR 0.62, 95% CI: 0.45-0.88; I²=55%). Length of stay was reduced by 1.09 days (95% CI: -1.68 to -0.50). Postoperative day 1 IL-6 was lower with glucocorticoids, while CRP showed no consistent difference. Anastomotic leak and mortality were not increased. Exploratory analyses suggested greater benefit with higher-dose regimens. CONCLUSIONS: Single-dose preoperative systemic glucocorticoids reduce postoperative morbidity, infections, and length of stay after major gastrointestinal surgery, without evidence of increased surgical harm in included trial populations.