Kwon Young Suk, Jang Ji Su, Hwang Sung Mi, Tark Hyunjin, Kim Jong Ho, Lee Jae Jun
Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University.
Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University.
Medicine (Baltimore). 2019 Jun;98(24):e15820. doi: 10.1097/MD.0000000000015820.
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.
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.
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).
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.
NCT03076827 (ClinicalTRrial.gov).
本研究旨在比较以高皮质醇水平为特征的上午手术（A组）和以低皮质醇水平为特征的下午手术（B组）在髋关节手术后的皮质醇、炎性细胞因子（白细胞介素[IL]-6、IL-8）及术后住院天数（POHD）方面的差异。
本研究为单中心、前瞻性、随机（1:1）平行组试验。接受全髋关节置换术或半关节置换术的患者根据手术开始时间随机分为两组：上午8点（A组）或下午1 - 2点（B组）。在手术当天上午7:30、麻醉诱导前以及术后6、12、24和48小时测量皮质醇和细胞因子水平。采用视觉模拟评分法（VAS）和POHD评估手术开始时间的临床效果。术后6、12、24和48小时测量VAS，出院时测量POHD。
共有44例患者完成试验。两组术后皮质醇水平存在显著差异（24小时，P <.001；48小时，P <.001）。B组皮质醇水平恢复至初始水平的患者百分比高于A组（P <.001）。术后12、24和48小时两组IL-6水平存在显著差异（P = 0.015；P = 0.005；P = 0.002），术后12和24小时IL-8水平存在显著差异（P = 0.002，P <.001）。两组在VAS和POHD方面无显著差异。然而，A组只有3例患者住院超过3周（P = 0.233）。
与上午手术相比，下午手术可使皮质醇更快恢复至基线水平，且术后1 - 2天时IL-6和IL-8水平更低。本研究结果表明，由于手术开始时间不同导致皮质醇、IL-6和IL-8存在差异，对于术后伤口愈合延迟或有炎症的患者，可考虑下午手术。
NCT03076827（ClinicalTRrial.gov）
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