Effects of surgery start time on postoperative cortisol, inflammatory cytokines, and postoperative hospital day in hip surgery

Abstract

Background: The aim of this study was to compare morning surgery (Group A), characterized by high cortisol levels, with afternoon surgery (Group B), characterized by low cortisol levels, with respect to cortisol, inflammatory cytokines (interleukin [IL]-6, IL-8), and postoperative hospital days (POHD) after hip surgery. Methods: The study was conducted in a single center, prospective, randomized (1:1) parallel group trial. Patients undergoing total hip replacement or hemiarthroplasty were randomly divided into two groups according to the surgery start time: 8 am (Group A) or 1–2 pm (Group B). Cortisol and cytokine levels were measured at 7:30 am on the day of surgery, before induction of anesthesia, and at 6, 12, 24, and 48 hours (h) after surgery. Visual analogue scale (VAS) and POHD were used to evaluate the clinical effect of surgery start time. VAS was measured at 6, 12, 24, and 48 h postoperatively, and POHD was measured at discharge. Results: In total, 44 patients completed the trial. The postoperative cortisol level was significantly different between the two groups. (24 h, P < .001; 48 h, P < .001). The percentage of patients whose level returned to the initial level was higher in Group B than in Group A ( P < .001). Significant differences in IL-6 levels were observed between the two groups at 12, 24, and 48 h after surgery ( P = .015; P = .005; P = .002), and in IL-8 levels at 12 and 24 h after surgery ( P = .002, P < .001). There was no significant difference between the two groups in VAS and POHD. However, only three patients in Group A were inpatients for more than 3 weeks ( P = .233). Conclusions: Afternoon surgery allowed for more rapid recovery of cortisol to the baseline level than morning surgery, and IL-6 and IL-8 were lower at 1–2 days postoperatively. The results of this study suggest that afternoon surgery may be considered in patients with postoperative delayed wound healing or inflammation because of the difference in cortisol, IL-6 and 8 in according to surgery start time. Clinical trial registration number: NCT03076827 (ClinicalTRrial.gov).

Impact of Acute Inflammation on Cytochromes P450 Activity Assessed by the Geneva Cocktail

“…39 In a randomized controlled study conducted in patients with elective hip surgery, cortisol levels indeed changed over time (P < 0.001). 40 The GR could also be implicated in CYP2C9 induction. 41 We established that CYP2C9 activity increased after surgery, and was correlated with IL-6 but not with CRP and TNF-α.…”

“…As cortisol, the glucocorticoid “stress hormone” binds the GRs, and increases under stress conditions, such as surgery, induction of CYP2B6 by surgery itself via the GR cannot be excluded 39 . In a randomized controlled study conducted in patients with elective hip surgery, cortisol levels indeed changed over time ( P < 0.001) 40 . The GR could also be implicated in CYP2C9 induction 41 …”

Efficacy of Listening to Murattal in Reducing the Pain Experienced by ICU Patients

“…Another factor that affects pain is the use of analgesic drugs and anesthetics in postoperative patients who are admitted to the ICU. The effects of anesthetics would only wear off after 24 hours (Kwon et al, 2019). The data collected in this study did not consider the time interval between the administration of anesthesia and data collection.…”

Comparative analysis of effects of three different doses of fentanyl and standard dose of bupivacaine on a spinal block in patients with hip endoprosthesis surgery

“…Kwon et al [23] hypothesized that circadian rhythm of cortisol might affect postoperative cortisol levels depending on the surgery start time. Cortisol recovery to preoperative level was faster in the afternoon surgery than in the morning surgery group.…”