Effect of preoperative, high-dose glucocorticoid on early cognitive function after abdominal wall reconstruction – A randomized controlled trial

Introduction: Preoperative high-dose glucocorticoid (GC) improves postoperative recovery and reduces length of stay but increases the risk of postoperative cognitive dysfunction (POCD). Whether preoperative high-dose GC increases the risk of POCD in abdominal wall reconstruction (AWR) is unknown. Material and methods: This was a double-blind randomized controlled trial examining the effect of 125 mg methylprednisolone (MP) iv versus placebo (saline) iv given as a single dose at anesthesia induction. Cognitive function was tested pre- and postoperatively by The Trail Making Test (TMT) A and TMT-B. Outcome of TMT is time (seconds) to complete the test; the longer the time, the worse the impairment. Primary endpoint was individual change preoperative to postoperative day (POD) 1 on TMT-B. Secondary endpoints were individual change preoperative to: POD1 on TMT-A, POD2 on TMT-A and TMT-B, and POD30 on TMT-A and TMT-B, respectively. Results: A total of 33 patients (MP: n = 17; placebo: n = 16) were analyzed for primary endpoint. There was no significant difference between the groups in primary endpoint (MP group median 1s (IQR -7 − 23) vs. placebo group median 12s (IQR -5 − 34), p = 0.521). The MP group was significantly faster than the placebo group preoperative to POD30 on TMT-A (MP group median −10s (IQR -16 − 4) vs. placebo group median -4s (IQR -8 – 1), p = 0.046). There were no significant differences in remaining secondary endpoints. Conclusion: Preoperative high-dose GC is not associated with increased risk of early POCD in elective AWR for a large incisional hernia.