Dexamethasone and Tonsillectomy Bleeding: A Meta-Analysis

Objective. To use meta-analytic techniques to examine the effect of dexamethasone on the risk of postoperative bleeding following tonsillectomy. Data Sources. PubMed and Embase databases accessed on April 23, 2009, and April 28, 2009. Review Methods. Using principles of meta-analysis, inclusion and exclusion criteria were developed to identify all randomized controlled trials of patients undergoing tonsillectomy in which perioperative intravenous dexamethasone was administered in at least 1 treatment arm and bleeding complications were reported. Electronic databases were searched to identify candidate articles. Two authors independently abstracted data from each article. Discrepancies were resolved by consensus. A fixed-effects model was used to pool relative risks among studies using the Mantel-Haenszel method. Studies were assessed for publication bias using a funnel plot of studies' effect size vs standard error of the effect size as well as Begg test and Egger test. A P value <.05 was considered significant. Results. The primary search identified 85 potential studies. Fourteen met inclusion criteria and were selected for meta-analysis. No significant heterogeneity was found among studies (I(2) < 0.1%; 95% confidence interval [CI], 0%-55%; P = .68). The pooled relative risk (RR) of postoperative bleeding did not differ significantly between patients receiving dexamethasone and controls (RR, 1.02; 95% CI, 0.65-1.61; P = .92). When studies were stratified by age, primary vs secondary hemorrhage, and follow-up duration, no further significant differences in bleeding rate were identified. No evidence of publication bias was found using Begg (P = .70) or Egger (P = .73) tests. Conclusion. The results of this meta-analysis indicate that perioperative dexamethasone does not confer an increased risk of postoperative bleeding in patients undergoing tonsillectomy.