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Objective: Does dexamethasone given before thyroidectomy reduce postoperative nausea and vomiting (PONV) in a randomized controlled trial? Background: PONV is an unsettling problem that commonly occurs in patients after thyroidectomy. Various preventive measures have been studied; however, many of these studies have been criticized for their biases (eg, use of opioids, sex selection) or were even retracted. Methods: This single-institution, randomized, double-blind, placebo-controlled, superiority study was performed between January 1, 2011, and May 30, 2013. Patients undergoing thyroidectomy for benign disease were allocated by a block randomized list to receive a preoperative single dose of dexamethasone (8 mg) or placebo. Patients and staff were blinded to the treatment assignment. The primary endpoint was the incidence of PONV assessed at 4, 8, 16, 24, 32, and 48 hours after surgery. To observe an incidence reduction of 50%, a total of 152 patients were required for the study. Results: The total incidence of PONV was reported in 65 of 152 patients (43%; 95% confidence interval [CI], 35-51). In the intention-to-treat analysis, PONV occurred in 22 of 76 patients (29%; 95% CI, 20-40) in the treatment arm and in 43 of 76 patients (57%; 95% CI, 45-67) in the control arm (P=0.001; odds ratio=0.31; 95% CI, 0.16-0.61; absolute risk reduction=28%; 95% CI, 12-42). The number needed to treat was 4. No severe dexamethasone-related adverse events were observed during the study. Conclusions: A single dose of preoperative dexamethasone administration is an effective, safe, and economical measure to reduce PONV incidence after thyroidectomy. [ABSTRACT FROM AUTHOR]

Objective: To assess the predictive value of C-reactive protein (CRP) level for postoperative infectious complications after colorectal surgery., Background: Postoperative infectious complications after colorectal surgery are frequent and associated with relevant short- and long-term sequelae. Therefore, the identification of a diagnostic tool for early recognition of postoperative infectious complications is of cardinal importance., Methods: A meta-analysis was performed for diagnostic studies evaluating CRP as a predictor for postoperative infectious complications on days 1 to 5 after colorectal surgery., Results: Six studies including a total of 1832 patients were identified. The best performance of CRP to predict postoperative infectious complications was on postoperative day 4, on which the mean CRP cutoff value was 135 mg/L (SD: 10 mg/L), the pooled sensitivity 68% (95% CI: 57%-79%), the specificity 83% (95% CI: 77%-90%) and the negative predictive value 89% (95% CI: 87%-92%). The pooled area under the receiver operating characteristic curve was 0.81 (95% CI: 0.73-0.89)., Conclusions: This diagnostic meta-analysis of 1832 patients--the first in the literature--provides compelling evidence that C-reactive protein on postoperative day 4 has a high negative predictive value for infectious complications of 89%. Therefore, CRP measurement allows safe and early discharge of selected patients after colorectal surgery.