Preoperative Methylprednisolone Enhances Recovery After Endovascular Aortic Repair
| Autor: | John B. Groenvall, Louise de la Motte, Henning B. Nielsen, Andreas Andersen, Henrik Kehlet, Torben V. Schroeder, Katja Vogt, Lars Lönn, Claus Henrik Nielsen |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Placebo Methylprednisolone law.invention Blood Vessel Prosthesis Implantation Aortic aneurysm Postoperative Complications Double-Blind Method Randomized controlled trial law Interquartile range medicine Humans Glucocorticoids Aged business.industry Interleukins Endovascular Procedures Length of Stay medicine.disease Systemic Inflammatory Response Syndrome Surgery Clinical trial Systemic inflammatory response syndrome Treatment Outcome Area Under Curve Anesthesia Preoperative Period Female business Aortic Aneurysm Abdominal medicine.drug Abdominal surgery |
| Zdroj: | Annals of Surgery. 260:540-549 |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0000000000000895 |
| Popis: | OBJECTIVE To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocorticoids may reduce postoperative inflammatory responses and enhance recovery, but with limited information on EVAR. METHODS A single-center, randomized, double-blind, placebo-controlled trial of 153 patients undergoing elective EVAR between November 2009 and January 2013. Patients received 30 mg/kg of methylprednisolone (MP) (n = 77) or placebo (n = 76) preoperatively. Primary outcome was a modified version of the systemic inflammatory response syndrome. Secondary outcome measures were the effect on inflammatory biomarkers, morbidity, and time to meet discharge criteria. RESULTS Of 153 randomized patients, 150 (98%) were evaluated for the primary outcome. MP reduced systemic inflammatory response syndrome from 92% to 27% (P < 0.0001) (number needed to treat = 1.5), maximal plasma interleukin 6 from 186 pg/mL [interquartile range (IQR) = 113-261 pg/mL] to 20 pg/mL (IQR = 11-28 pg/mL) (P < 0.001) and fulfillment of discharge criteria was shorter [2 days (IQR = 2-4 days) vs 3 days (IQR = 3-4 days)] (P < 0.001). C-reactive protein, temperature, interleukin 8, and soluble tumor necrosis factor receptor were also reduced (P < 0.001) by MP. Myeloperoxidase, D-dimer, and matrix metalloproteinase 9 were not modified. No differences in 30-day medical (23% vs 36%) (P = 0.1) or surgical (20% vs 21%) morbidity were found in the active group versus the placebo group. CONCLUSIONS Preoperative MP attenuates the inflammatory response with a faster recovery after EVAR for abdominal aortic aneurysms. Further safety and dose-response studies are required to allow recommendations for general practice. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00989729. |
| Databáze: | OpenAIRE |
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