Perioperative Corticosteroid Reduces Hospital Stay After Fronto-Orbital Advancement

Facial swelling is common after fronto-orbital advancement. Edema and closure of the palpebral fissures can lead to prolonged hospitalization. The purpose of this study was to determine if perioperative corticosteroid shortens hospital stay after this procedure.We retrospectively studied consecutive children younger than 2 years who underwent primary fronto-orbital advancement between 1990 and 2008. Patients were categorized into 2 groups: group 1 patients were not given corticosteroid; group 2 patients received tapered perioperative dexamethasone. Primary outcome variables included length of hospital stay and infection rate.A total of 161 patients were included in the study. Hospitalization was significantly shorter (P = 0.008) for group 2 (n = 65; median duration, 3.0 d) than group 1 (n = 96; median duration, 5.0 d). Infection rates did not differ between groups (group 1, 2.1%; group 2, 1.5%; P = 0.8).Perioperative corticosteroid shortens hospitalization after fronto-orbital advancement without increasing the incidence of postoperative infection. The cost of postoperative hospital care was reduced by 27.2%.

[1]  S. Engum,et al.  Steroids and poor nutrition are associated with infectious wound complications in children undergoing first stage procedures for ulcerative colitis. , 2008, Surgery.

[2]  J. Meara,et al.  Tumescent steroid infiltration reduces postoperative eye closure after craniofacial surgery. , 2008, Plastic and reconstructive surgery.

[3]  K. Saag,et al.  The epidemiology of glucocorticoid-associated adverse events , 2008, Current opinion in rheumatology.

[4]  Sebastian Schneeweiss,et al.  Anti-tumor necrosis factor α therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis , 2007 .

[5]  M. McKee.  Efficacy and safety of steroid use for postoperative pain relief. , 2007, The Journal of bone and joint surgery. American volume.

[6]  C. Coté,et al.  There Is No Dose-Escalation Response to Dexamethasone (0.0625–1.0 mg/kg) in Pediatric Tonsillectomy or Adenotonsillectomy Patients for Preventing Vomiting, Reducing Pain, Shortening Time to First Liquid Intake, or the Incidence of Voice Change , 2007, Anesthesia and analgesia.

[7]  A. Silman,et al.  Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis , 2006, Annals of the rheumatic diseases.

[8]  Michael C. Bateman,et al.  Short-Stay Cleft Palate Surgery With Intraoperative Dexamethasone and Marcaine , 2006, Annals of plastic surgery.

[9]  R. Hermann,et al.  Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. , 2006, The Journal of bone and joint surgery. American volume.

[10]  W. Sandborn,et al.  Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[11]  A. Stubhaug,et al.  Methylprednisolone Reduces Pain, Emesis, and Fatigue After Breast Augmentation Surgery: A Single-Dose, Randomized, Parallel-Group Study with Methylprednisolone 125 mg, Parecoxib 40 mg, and Placebo , 2006, Anesthesia and analgesia.

[12]  S. Mckean,et al.  Use of intravenous steroids at induction of anaesthesia for adult tonsillectomy to reduce post‐operative nausea and vomiting and pain: a double‐blind randomized controlled trial , 2006, Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery.

[13]  Frederick Wolfe,et al.  Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. , 2006, Arthritis and rheumatism.

[14]  J. Cidlowski,et al.  Antiinflammatory action of glucocorticoids--new mechanisms for old drugs. , 2005, The New England journal of medicine.

[15]  A. Bhatia,et al.  Prophylactic Dexamethasone for Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Dose Ranging and Safety Evaluation Study , 2005, Anesthesia and analgesia.

[16]  A. Shetty,et al.  Chronic steroid and immunosuppressant therapy in children. , 2004, Pediatrics in review.

[17]  E. Kargı,et al.  Effect of Steroids on Edema, Ecchymosis, and Intraoperative Bleeding in Rhinoplasty , 2003, Annals of plastic surgery.

[18]  J. Rosenberg,et al.  Preoperative Dexamethasone Improves Surgical Outcome After Laparoscopic Cholecystectomy: A Randomized Double-Blind Placebo-Controlled Trial , 2003, Annals of surgery.

[19]  Steve Eubanks,et al.  Consensus Guidelines for Managing Postoperative Nausea and Vomiting , 2003, Anesthesia and analgesia.

[20]  H. Kehlet,et al.  Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. , 2002, Journal of the American College of Surgeons.

[21]  R. Hayward,et al.  Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery. , 2001, British journal of plastic surgery.

[22]  A. Baraka,et al.  The Effect of Dexamethasone on Postoperative Vomiting After Tonsillectomy , 2001, Anesthesia and analgesia.

[23]  P. White,et al.  Dexamethasone Facilitates Discharge After Outpatient Anorectal Surgery , 2001, Anesthesia and analgesia.

[24]  S. Sauerland,et al.  Risks and Benefits of Preoperative High Dose Methylprednisolone in Surgical Patients , 2000, Drug safety.

[25]  G. Wong,et al.  Analysis of Fronto-orbital Advancement for Apert, Crouzon, Pfeiffer, and Saethre-Chotzen Syndromes , 2000, Plastic and reconstructive surgery.

[26]  N. Graudal,et al.  The association of variant mannose-binding lectin genotypes with radiographic outcome in rheumatoid arthritis. , 2000, Arthritis and rheumatism.

[27]  R. Sapolsky,et al.  How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. , 2000, Endocrine reviews.

[28]  B. Walder,et al.  Dexamethasone for the Prevention of Postoperative Nausea and Vomiting: A Quantitative Systematic Review , 2000, Anesthesia and analgesia.

[29]  C. Kara,et al.  Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. , 1999, Plastic and reconstructive surgery.

[30]  J. Mulliken,et al.  Complications of systemic corticosteroid therapy for problematic hemangioma. , 1999, Plastic and reconstructive surgery.

[31]  S. Dimmeler,et al.  Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery. , 1999, The European journal of surgery = Acta chirurgica.

[32]  K. Moos,et al.  Randomized prospective study of the influence of steroids on postoperative eye-opening after exploration of the orbital floor. , 1999, The British journal of oral & maxillofacial surgery.

[33]  J. Raeder,et al.  Betamethasone Reduces Postoperative Pain and Nausea After Ambulatory Surgery , 1998, Anesthesia and analgesia.

[34]  R. Sukhani,et al.  The Effect of Preoperative Dexamethasone on the Immediate and Delayed Postoperative Morbidity in Children Undergoing Adenotonsillectomy , 1998, Anesthesia and analgesia.

[35]  P. Barnes,et al.  Anti-inflammatory actions of glucocorticoids: molecular mechanisms. , 1998, Clinical science.

[36]  J. Brokloff.  Effect of prednisolone on the systemic response and wound healing after colonic surgery , 1997 .

[37]  Jack C. Yu,et al.  Infections in Craniofacial Surgery: A Combined Report of 567 Procedures from Two Centers , 1997, Plastic and reconstructive surgery.

[38]  J. Owsley,et al.  Does steroid medication reduce facial edema following face lift surgery? A prospective, randomized study of 30 consecutive patients. , 1996, Plastic and reconstructive surgery.

[39]  J. Church,et al.  Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis , 1996, Diseases of the colon and rectum.

[40]  M. April,et al.  The effect of intravenous dexamethasone in pediatric adenotonsillectomy , 1996 .

[41]  L. Bass,et al.  Influence of Steroids on Postoperative Swelling after Facialplasty: A Prospective, Randomized Study , 1995, Plastic and reconstructive surgery.

[42]  C. R. Weber,et al.  Evaluation of dexamethasone for reducing postoperative edema and inflammatory response after orthognathic surgery. , 1995, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[43]  B. Ramsahoye,et al.  Lesson of the Week: The mineralocorticoid effects of high dose hydrocortisone , 1995, BMJ.

[44]  D. Mangat,et al.  Effects of steroids on mood, edema, and ecchymosis in facial plastic surgery. , 1994, Archives of otolaryngology--head & neck surgery.

[45]  D. Furst,et al.  Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. , 1994, The American journal of medicine.

[46]  K. Lavery,et al.  Dexamethasone reduces pain and swelling following extraction of third molar teeth , 1993, Anaesthesia.

[47]  L. Brodsky,et al.  The Effects of Preoperative Steroids on Tonsillectomy Patients , 1993, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[48]  R. Fessler,et al.  The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease. , 1993, Journal of neurosurgery.

[49]  Tom D. Wang,et al.  Steroids and rhinoplasty. A double-blind study. , 1991, Archives of otolaryngology--head & neck surgery.

[50]  S. Sagar.  The current role of anti-emetic drugs in oncology: a recent revolution in patient symptom control. , 1991, Cancer treatment reviews.

[51]  C. Senders,et al.  Factors influencing palatoplasty and pharyngeal flap surgery. , 1991, Archives of otolaryngology--head & neck surgery.

[52]  H. Kehlet,et al.  Effect of combined prednisolone, epidural analgesia and indomethacin on pain, systemic response and convalescence after cholecystectomy. , 1990, Acta chirurgica Scandinavica.

[53]  K. Kennedy,et al.  Steroids in rhinoplasty , 1989, The Laryngoscope.

[54]  J. Vargas,et al.  Corticosteroids and anterior cruciate ligament repair , 1989, The American journal of sports medicine.

[55]  M. Heideman,et al.  Inhibition of complement activation by high-dose corticosteroids in total hip arthroplasty. , 1988, Clinical orthopaedics and related research.

[56]  R. Nordström,et al.  The effect of corticosteroids on postoperative edema. , 1987, Plastic and reconstructive surgery.

[57]  I. Munro,et al.  Effect of Steroids in Maxillofacial Surgery , 1986, Annals of plastic surgery.

[58]  C. B. Stuller,et al.  Effect of methylprednisolone on swelling after orthognathic surgery. , 1984, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[59]  A. Harris,et al.  CYTOTOXIC-THERAPY-INDUCED VOMITING IS MEDIATED VIA ENKEPHALIN PATHWAYS , 1982, The Lancet.

[60]  S. Young.  MECHANISM OF DECLINE IN RAT BRAIN 5‐HYDROXYTRYPTAMINE AFTER INDUCTION OF LIVER TRYPTOPHAN PYRROLASE BY HYDROCORTISONE: ROLES OF TRYPTOPHAN CATABOLISM AND KYNURENINE SYNTHESIS , 1981, British journal of pharmacology.

[61]  P. Disaia,et al.  Methylprednisolone as an antiemetic during cancer chemotherapy--a pilot study. , 1980, Gynecologic oncology.

[62]  D. Lockwood,et al.  Pituitary adrenal recovery following short-term suppression with corticosteroids. , 1979, The American journal of medicine.

[63]  A. Parker,et al.  ADRENAL SUPPRESSION AFTER SHORT-TERM CORTICOSTEROID THERAPY , 1979, The Lancet.

[64]  M. Habal,et al.  Experimental facial edema: treatment with methylprednisolone. , 1978, The Journal of surgical research.

[65]  T. Tomkin,et al.  RECOVERY IN A CASE OF HYDROPHOBIA AFTER EXCISION OF THE BITTEN PARTS. , 1835 .

[66]  F. F. Mutaz B. Habal M.D..  Prevention of postoperative facial edema with steroids after facial surgery , 2005, Aesthetic Plastic Surgery.

[67]  J. Miles,et al.  Factors affecting the incidence of wound infection in neurosurgery , 2005, Acta Neurochirurgica.

[68]  T. Assimes,et al.  The use of perioperative corticosteroids in craniomaxillofacial surgery. , 1999, Plastic and reconstructive surgery.

[69]  K. E. Newhouse.  Goodman and Gilman's The Pharmacological Basis of Therapeutics , 1986, The Yale Journal of Biology and Medicine.

[70]  T. Hyrkäs.  Effect of preoperative single doses of diclofenac and methylprednisolone on wound healing. , 1994, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[71]  T. Hyrkas.  Effect of preoperative single doses of diclofenac and methylprednisolone on wound healing. , 1994 .

[72]  D. B. Osbon,et al.  Hypothalamic-pituitary-adrenal suppression after short-term dexamethasone therapy for oral surgical procedures. , 1980, Journal of oral surgery.

[73]  S. E. Smith.  Adrenocortical steroids. , 1971, Nursing times.