AHA STEROID
Trial question
What is the role of preoperative high-dose dexamethasone in patients undergoing emergency laparotomy?
Study design
Single center
Double blinded
RCT
Population
120 patients.
Inclusion criteria: patients with intestinal obstruction and perforated viscus undergoing emergency laparotomy.
Key exclusion criteria: appendectomy, cholecystectomy, negative diagnostic laparoscopy/laparotomy; emergency re-operation after elective surgery; reoperation owing to fascial separation; intestinal ischemia; intra-abdominal bleeding.
Interventions
N=60 dexamethasone (preoperative intravenous infusion of 1 mg/kg).
N=60 placebo (intravenous infusion of normal saline).
Primary outcome
Median C-reactive protein on postoperative day 1
170 mg/L
220 mg/L
220.0 mg/L
165.0 mg/L
110.0 mg/L
55.0 mg/L
0.0 mg/L
Dexamethasone
Placebo
Significant
decrease ▼
Significant decrease in median CRP on postoperative day 1 (170 mg/L vs. 220 mg/L; MD -49, 95% CI -85 to -13).
Secondary outcomes
Significant decrease in death at day 90 (7% vs. 23%; RR 0.33, 95% CI 0.11 to 0.93).
Significant decrease in postoperative major complications (27% vs. 45%; RR 0.62, 95% CI 0.37 to 1).
Significant decrease in median CRP on postoperative day 1 in patients with intestinal obstruction (60 mg/L vs. 160 mg/L; MD -100, 95% CI -163.26 to -36.74).
Conclusion
In patients with intestinal obstruction and perforated viscus undergoing emergency laparotomy, dexamethasone was superior to placebo with respect to median CRP on postoperative day 1.
Reference
Mirjana Cihoric, Henrik Kehlet, Morten L Lauritsen et al. Preoperative high dose of dexamethasone in emergency laparotomy: randomized clinical trial. Br J Surg. 2024 Jul 2;111(7):znae130.
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