Complement activation and release of interleukin-6 and tumour necrosis factor-alpha in drained and systemic blood after major orthopaedic surgery.

OBJECTIVE

To measure the concentration of complement activation products C3bc and terminal complement complex (TCC) and the cytokines interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-alpha) in systemic and drained wound blood for the first six hours after a major orthopaedic operation.

DESIGN

Prospective study.

SETTING

University hospital, Norway.

PATIENTS

8 patients operated on for thoracic scoliosis.

MAIN OUTCOME MEASURE

Concentrations of complement activation products, IL-6 and TNF-alpha in arterial (systemic) and drained (local) blood were measured at wound closure and 1, 2, 4, and 6 hours postoperatively.

RESULTS

C3bc and TCC were 10 times higher, and IL-6 showed extreme values, in drained compared with arterial blood. The concentration of TNF-alpha did not increase significantly, either in drained or in arterial blood. The white cell count (WCC) increased threefold in both drained and arterial blood compared with arterial control values before operation.

CONCLUSION

Complement activation and IL-6 release after surgical trauma differ significantly in local and systemic blood samples. Conclusions based only on systemic findings may be limited.