A Systematic Review and Meta-Analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers

Abstract

BACKGROUND: Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty. METHODS: MEDLINE, Embase, Cochrane, and CINAHL databases were searched (Inception to June 23, 2020). Observational or experimental studies reporting the perioperative level or activity of biomarkers in surgical patients stratified by age or frailty status were included. The primary outcome was inflammatory biomarkers (grouped by window of ascertainment: pre-op; post-op: <12 hours, 12–24 hours, 1–3 days, 3 days to 1 week, and >1 week). Quality assessment was conducted using the Newcastle-Ottawa Scale. Inverse-variance, random-effects meta-analysis was conducted. RESULTS: Forty-five studies (4263 patients) were included in the review, of which 36 were pooled for meta-analysis (28 noncardiac and 8 cardiac studies). Two studies investigated frailty as the exposure, while the remaining investigated age. In noncardiac studies, older patients had higher preoperative levels of interleukin (IL)-6 and C-reactive protein (CRP), lower preoperative levels of lymphocytes, and higher postoperative levels of IL-6 (<12 hours) and CRP (12–24 hours) than younger patients. In cardiac studies, older patients had higher preoperative levels of IL-6 and CRP and higher postoperative levels of IL-6 (<12 hours and >1 week). CONCLUSIONS: Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.

Usability and feasibility of a digital cognitive screening tool measuring older adults’ early postoperative neurocognitive recovery: a protocol for a pilot study

“… 12 One hypothetical mechanism is that older adults have an unregulated acute inflammatory response to surgery. 13 So far, an explicit connection between POCD and neuroinflammation due to the surgical trauma has been confirmed. 7 14 The American Geriatrics Society’s guidelines 9 recommend that every geriatric perioperative patient with risk factors, should be assessed for their cognitive performance prior surgery.…”

“…Moreover, results have been inconclusive regarding the role of intraoperative factors such as type of anaesthesia, hypotension, cerebral saturation or choice of anaesthetic drugs for the development of POCD 12. One hypothetical mechanism is that older adults have an unregulated acute inflammatory response to surgery 13. So far, an explicit connection between POCD and neuroinflammation due to the surgical trauma has been confirmed 7 14.…”

Revitalizing Postoperative Pain Management in Enhanced Recovery After Surgery via Inter-departmental Collaboration Toward Precision Medicine: A Narrative Review

“…Beyond the realms of preoperative risk assessment and monitoring, the expansive potential of AI becomes evident in its ability to harmonize and dissect past patient data (e.g., anesthesia or procedural sedation history) alongside intricate pathophysiological insights, thereby heralding a new era of personalized anesthesia management, inclusive of perioperative pain management leading to active rehabilitation [ 32 , 33 ]. In other words, there is a possibility of further ERAS improvement.…”

“The Big Three” of geriatrics: A review of perioperative cognitive impairment, frailty and malnutrition

“…A recently published meta-analysis on the impact of age on perioperative inflammatory biomarkers, which included 45 studies, showed that in both cardiac and non-cardiac studies, older patients had higher pre-operative levels of interleukin (IL)-6 and C-reactive protein (CRP) and higher postoperative levels of IL-6 than younger patients. [ 10 ]…”