Effects of Glucocorticoids on Postoperative Delirium in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis

Purpose: Delirium is a common neurologic complication after cardiac surgery and is associated with a poor prognosis. Several studies have explored the effects of glucocorticoids on postoperative delirium (POD). However, conclusion have been inconsistent. The purpose of this systematic review and meta-analysis is to evaluate the effects of glucocorticoids on POD in adult patients undergoing cardiac surgery.

Methods: A systematic literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Library/Central, and Web of Science from inception to January 28, 2021. Randomized controlled trials evaluating the effects of perioperative glucocorticoids administration on the incidence of POD in adults (≥18 years of age) undergoing cardiac surgery were included. The primary outcome of incidence of POD was assessed using the risk ratio (RR) with a fixed-effects model. Secondary analyses included the severity or duration of delirium, mortality at 30 days, length of hospital and intensive care unit (ICU) stay, duration of mechanical ventilatory support, the incidence of myocardial injury, new atrial fibrillation, renal and respiratory failure, postoperative infection and stroke, and the level of glucose and inflammatory factors.

Findings: A total 4 trials (n = 8448 patients) were included. Glucocorticoids did not significantly reduce the incidence of POD (RR = 0.99; 95% CI, 0.86-1.14) but increased the risk of myocardial injury (RR = 1.22; 95% CI, 1.08-1.38), decreased the duration of mechanical ventilatory support (mean difference, -0.83; 95% CI, -1.32 to -0.34), and led to a tendency toward short length of ICU stay (mean difference, -0.22; 95% CI, -0.47 to -0.03). No significant differences were observed in other secondary outcomes.

Implications: The perioperative administration of glucocorticoids did not reduce the incidence of POD in adult patients undergoing cardiac surgery but might be associated with shorter duration of mechanical ventilatory support and a tendency toward a shorter length of ICU stay. Furthermore, we found that glucocorticoids may increase the rate of myocardial injury but have no effects on other clinical outcomes. International Prospective Register of Systematic Reviews identifier: CRD42021233458.