Effect of prednisolone on the systemic response and wound healing after colonic surgery

S. Schulze, J. Andersen, H. Overgaard, P. Norgard, H. J. Nielsen, A. Aasen, F. Gottrup and H. Kehlet
Department of Surgery, Sundby Hospital, Copenhagen, Denmark.

OBJECTIVE: To study the effect of preoperative treatment with a single high-dose glucocorticoid on the systemic and immunologic responses, wound healing, and convalescence after colonic surgery. DESIGN: Double-blind, placebo-controlled, randomized trial. SETTING: Department of surgery in a university hospital. PATIENTS: Thirty patients scheduled for open colonic resection; 6 patients were excluded from the study (N = 24). INTERVENTIONS: Patients were randomized to either of 2 treatment regimens: methylprednisolone sodium succinate 90 minutes before induction of anesthesia and epidural analgesia (group 1, n = 12), or placebo 90 minutes before anesthesia and epidural analgesia (group 2, n = 12). MAIN OUTCOME MEASURES: Assessments of pain, pulmonary function, convalescence, and various injury and wound-healing factors were done several times until 10 days after surgery. RESULTS: Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activations were significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effects on collagen accumulation. CONCLUSION: Treatment with a single high-dose glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.