Perioperative Corticosteroids Reduce Short-Term Edema and Ecchymosis in Rhinoplasty: A Meta-Analysis

Overview

Several small randomised trials had tested steroids for rhinoplasty swelling, none large enough to settle the question, and three previous reviews reached three different conclusions. The authors ran a formal meta-analysis, searching electronic databases without language restriction, applying the Cochrane risk of bias tool and grading the quality of evidence with GRADE.

Sections of note

• Included trials compared systemic steroids given around surgery against placebo, and reported at least one of swelling, bruising, bleeding, cosmetic outcome or satisfaction.
• Eight trials with 336 patients in total were pooled.
• Steroids reduced the worst swelling, standardised mean difference minus 1.03, 95 percent confidence interval minus 1.30 to minus 0.76, p less than 0.001.
• Steroids reduced the worst bruising, standardised mean difference minus 0.78, p less than 0.001.
• At one day after surgery a single dose reduced swelling, minus 1.15, and bruising, minus 0.79, both p less than 0.001.
• No benefit for swelling or bruising remained at seven days, and bleeding during surgery did not increase. Level of evidence 2.

What it means for a patient

• A steroid dose around the operation visibly reduces swelling and bruising in the first day or two.
• By one week the difference has gone, so the effect shortens the worst of the recovery rather than the whole of it.
• The steroid did not make bleeding during surgery worse, which was a stated concern.
• The pooled trials did not measure patient satisfaction or the eventual appearance of the nose, which the authors name as the gap for future trials to fill.

Why this paper matters

It resolves a question that three earlier reviews had answered differently, using a rigorous method and grading the evidence as high quality for the short-term effect. That makes it the reference point for a routine many surgeons already follow. What remains unknown is whether reducing early swelling changes how patients rate their result.

Terms

• Corticosteroid: a drug that suppresses inflammation and swelling.
• Perioperative: the period immediately before, during and after an operation.
• Edema: fluid swelling in tissue.
• Ecchymosis: bruising, blood visible under the skin.
• Standardised mean difference: a way of expressing effect size when trials used different scales.
• GRADE: a system for rating how much confidence to place in pooled evidence.