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Preoperative Methylprednisolone Enhances Recovery after Endovascular Aortic Repair
Louise de la Motte*, Henrik Kehlet, Katja Vogt*, Claus H Nielsen*, John Groenvall*, Henning B Nielsen*, Andreas Andersen*, Torben V Schroeder*, Lars Lönn*
Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
OBJECTIVE: The post-implantation inflammatory syndrome following endovascular aortic repair (EVAR) may hinder early recovery. Therefore, we evaluated the effect of a preoperative high-dose glucocortocoid on the inflammatory response and recovery after EVAR.
METHODS: A single-center, randomized, double-blinded, placebo-controlled trial of 153 patients undergoing EVAR for abdominal aortic aneurysm between November 2009 and January 2013. Patients received a single preoperative dose of 30 mg/kg methylprednisolone (n=77) or placebo (n=76). A modified version of the systemic inflammatory response syndrome (SIRS) was assessed during the first 4 postoperative days. Secondary outcome measures were plasma interleukin-6 levels and time to fulfillment of discharge criteria.
RESULTS: Of the 153 patients randomized, 150 (98%) could be evaluated for the primary outcome. Methylprednisolone led to a reduction in the modified SIRS from 92% to 27% (p<0.0001) (NNT =1.5), a reduction in maximal plasma IL-6 from 186 pg/ml (IQR 113;261 pg/ml) to 20 pg/ml (IQR 11;28 pg/ml) (p<0.001) as well as time to fulfillment of discharge criteria was shorter 2 days (IQR 2;4 days) vs. 3 days (IQR 3;4 days) (p<0.001). No differences in 30-day medical 23% vs. 36% (p=0.1) or surgical 20% vs. 21% morbidity were found in the active vs. placebo treatment group.
CONCLUSION: Preoperative methylprednisolone attenuates the postoperative inflammatory response resulting in a faster recovery after EVAR for abdominal aortic aneurysms. Further safety studies are called for to allow recommendations for general practice.
Trial registration: clinicaltrials.gov Identifier: NCT00989729.
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