A meta-analysis of pre-and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery

Abstract Introduction Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. Objective We conducted this systematic review and meta-analysis to determine the effect of preand postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. Methods A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of preor postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. Results Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. Conclusion This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

摘要 引言
面部整形手术后的水肿与瘀斑，是令患者与术者均深感困扰的临床问题。既往认为，给予糖皮质激素（corticosteroid）可缩短康复周期，减轻此类后遗症。但关于糖皮质激素给药疗效的相关数据，在外科医师中仍存在争议。
目的
本研究开展此项系统评价与荟萃分析，旨在通过不同亚组分析，明确术前与术后糖皮质激素应用对接受面部重建手术患者术后并发症的影响。
方法
截至2019年10月，我们在PubMed、Cochrane Central、SCOPUS及EBSCO数据库中开展了全面的文献检索。纳入所有探讨糖皮质激素对各类面部整形手术患者术后并发症影响的临床试验。我们依据糖皮质激素制剂的类型与剂量开展亚组分析，同时针对术前或术后糖皮质激素给药方案进行亚组分析。所有统计分析均采用RevMan软件完成。
结果
本项系统评价共纳入19项研究，但其中仅10项符合荟萃分析的纳入标准。与安慰剂组相比，糖皮质激素组的眶周水肿与瘀斑评分显著降低，分别为−0.82，95%置信区间（CI：−1.37, −0.26）与−0.95，95%置信区间（CI：−1.32, −0.57）。但上述显著差异在术后第3天及第7天时并未持续存在。小剂量糖皮质激素（8mg与10mg）对应的上下眼睑水肿与瘀斑平均评分差异较小，而大剂量糖皮质激素则对应更大的评分差异。此外，对于每日剂量＞50mg的大剂量糖皮质激素，术前给药可较安慰剂显著减少术中出血量（p＜0.0001），但8mg剂量的糖皮质激素未观察到该效应（p=0.06）。相较于仅术前给药，术前联合术后糖皮质激素给药方案可进一步减轻水肿与瘀斑。
结论
此项全面的荟萃分析证实，术前应用糖皮质激素具有统计学意义上的显著获益。此外，术后继续给予糖皮质激素可长期降低并发症发生率。大剂量糖皮质激素对应更显著的水肿与瘀斑减轻效果，但仍需开展进一步研究以明确其术后不良反应，包括手术部位感染与愈合延迟。