(A950) Steroid Use After Pediatric Tonsillectomy: A Systematic Review and Meta-Analysis

Introduction: Codeine-containing products for postoperative pain in pediatric adenotonsillectomy was contraindicated in 2013, prompting a search for alternative analgesic methods. This systematic review examines whether postoperative steroids improve clinical outcomes in pediatric patients following tonsillectomy, specifically focusing on reduction of pain, nausea, vomiting, and postoperative hemorrhage.

Methods: A comprehensive literature search of MEDLINE/PubMed databases was conducted for studies published between February 20, 2013 and December 5, 2024. Inclusion criteria encompassed randomized controlled trials, cohort studies, and observational studies investigating postoperative steroid use in pediatric tonsillectomy patients reporting outcomes of pain, nausea, vomiting, or hemorrhage. Data extraction focused on steroid type, dosage, timing, and primary outcomes. Statistical analysis was conducted using a random-effects model to calculate pooled risk ratios for hemorrhage rates.

Results: Seven studies met inclusion criteria. The studies exhibited heterogeneity in steroid type, dose, and timing. Pain outcomes varied, with three of four studies reporting significant reductions at specific postoperative time points. The pooled analysis of postoperative hemorrhage rates showed no significant reduction in postoperative hemorrhage rates (RR 0.88, 95% CI 0.55-1.41, p=0.60). Only two studies examined nausea and vomiting; one reported significant reductions, while the other found no differences.

Conclusions: This study underscores the lack of research on steroid use after pediatric tonsillectomy. While evidence suggests that postoperative steroids may reduce pain and potentially alleviate nausea and vomiting, the findings remain inconsistent due to variations in study design and steroid regimens. Importantly, steroids did not appear to significantly impact the rates of postoperative hemorrhage. The limited number and heterogeneity of studies highlights the need for future research to determine the role of steroids in the recovery period after pediatric tonsillectomy.