• Louise de la Motte, Henrik Kehlet, Katja Vogt, Claus H Nielsen, John B Groenvall, Henning B Nielsen, Andreas Andersen, Torben V Schroeder, and Lars Lönn.
• *Dept. of Vascular Surgery, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark †Section for Surgical Pathophysiology, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark ‡Institute for Inflammation Research, Dept. of Infectious Diseases and Rheumatology, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark §Dept. of Cardiovascular Radiology, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark ¶Dept. of Anesthesiology, Rigshospitalet, and University of Copenhagen, Copenhagen, Denmark ‖Center for Clinical Education, Capital Region of Denmark, and University of Copenhagen, Copenhagen, Denmark.
• Ann. Surg. 2014 Sep 1; 260 (3): 540-8; discussion 548-9.

ObjectiveTo evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR).BackgroundThe postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocorticoids may reduce postoperative inflammatory responses and enhance recovery, but with limited information on EVAR.MethodsA single-center, randomized, double-blind, placebo-controlled trial of 153 patients undergoing elective EVAR between November 2009 and January 2013. Patients received 30 mg/kg of methylprednisolone (MP) (n = 77) or placebo (n = 76) preoperatively. Primary outcome was a modified version of the systemic inflammatory response syndrome. Secondary outcome measures were the effect on inflammatory biomarkers, morbidity, and time to meet discharge criteria.ResultsOf 153 randomized patients, 150 (98%) were evaluated for the primary outcome. MP reduced systemic inflammatory response syndrome from 92% to 27% (P < 0.0001) (number needed to treat = 1.5), maximal plasma interleukin 6 from 186 pg/mL [interquartile range (IQR) = 113-261 pg/mL] to 20 pg/mL (IQR = 11-28 pg/mL) (P < 0.001) and fulfillment of discharge criteria was shorter [2 days (IQR = 2-4 days) vs 3 days (IQR = 3-4 days)] (P < 0.001). C-reactive protein, temperature, interleukin 8, and soluble tumor necrosis factor receptor were also reduced (P < 0.001) by MP. Myeloperoxidase, D-dimer, and matrix metalloproteinase 9 were not modified. No differences in 30-day medical (23% vs 36%) (P = 0.1) or surgical (20% vs 21%) morbidity were found in the active group versus the placebo group.ConclusionsPreoperative MP attenuates the inflammatory response with a faster recovery after EVAR for abdominal aortic aneurysms. Further safety and dose-response studies are required to allow recommendations for general practice.Trial Registrationclinicaltrials.gov Identifier: NCT00989729.

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