Systematic Review of Steroid Prophylaxis for Thyroidectomy

Abstract

Objective: Determine whether systematic review with meta-analysis supports the use of corticosteroids to reduce postoperative nausea, vomiting, pain, and voice dysfunction after thyroidectomy. Method: A systematic review of currently available randomized controlled trials in EMBASE and PUBMED databases comparing intravenous perioperative corticosteroids with placebo to prevent postoperative nausea, vomiting, pain, or voice dysfunction was performed by 2 independent reviewers. The quality of studies was evaluated and results synthesized using standard random-effects meta-analysis methods. Results: Eight randomized controlled trials were eligible for review. Dexamethasone reduced the absolute incidence of postoperative nausea at 24h by 18% (95% CI, 2-8-27%), P < .001, and postoperative vomiting at 24h by 27% (95% CI, 13-40%), P < .001 in 4 trials with 304 patients. Dexamethasone increased the absolute incidence of complete response (no episodes of nausea or vomiting) to steroids by 30% (95% CI, 7-52%), P = .11 in 3 trials with 246 patients. Dexamethasone reduced the absolute VAS score for pain (0-10 scale) at 24h by 1.32 95% CI (0.49-2.15), P = .002 in 3 trials with 232 patients. There was insufficient data to perform meta-analysis for voice dysfunction. Conclusion: These results argue strongly for routine use of dexamethasone during thyroidectomy because the intervention is safe and only about 2.5 patients need treatment to prevent one episode of postoperative nausea or vomiting.