Reacción inflamatoria sistémica y activación de citoquinas tras la cirugía abierta de aorta abdominal con medidas perioperatorias fast-track. Estudio prospectivo aleatorizado

Abstract

IntroductionThe aim of this study was to determine the incidence of systemic inflammatory response syndrome (SIRS) and cytokines release in patients after open abdominal aortic surgery with fast-track compared to those with conventional peri-operative management. Material and methodsA prospective, single centre, randomised study was conducted from October 2015-November 2017 that included consecutive patients undergoing open abdominal aortic surgery. Two groups were established: fast-track group (GFT) and conventional group (GC) depending on the peri-operative management. GFT peri-operative management consisted of: a carbohydrate drink 2hours before surgery, analgesia using pre-peritoneal elastomer, mobilisation, and early diet. The main demographic and perioperative variables were collected, and the levels of serum cytokines (TNFα, IL-1ß, IL-6, IL-8, IL-10, and IL-12p70) were analysed at baseline, 8, 24, and 48hours, post-operatively. The SIRS incidence was recorded in the first 72hours after surgery, as well as the mortality and complications rate during admission. ResultsA total of 49 patients were included (GFT: 26, GC: 23) with a mean age of 67.8±8.6 years, of whom 91.8% were men. Both groups were comparable in demographic and perioperative variables, except in terms of the pre-operative body mass index: GFT: 25.67±3.07 vs. GC: 29.29±4.66 (P=.008) and total clamping time: GFT: 52.4±12.63 vs. GC: 63.91±14.34min (P=.005). The incidence of SIRS in GFT vs. GC was 38.5% vs. 45.5%, 38.5% vs. 45.5%, 23.1% vs. 26.1%, 15.4% vs. 19% (P>.05) at 8, 24, 48, and 72h postoperatively, respectively. As regards serum cytokines, a higher release of IL-6, IL-8, IL-10 and TNFα in GC was observed compared to GFT. At 8h, IL-6 reached a statistically significant increase compared to baseline in GC (P=.045). At 24h, the IL-10 increased compared to the baseline, and was statistically higher in GC compared to GFT (P=.024). Acute renal failure was observed in the GC (6/23, 26.1%) and 1/26 (3.8%) in GFT (P=.041). ConclusionsOpen abdominal aortic surgery showed a high incidence of SIRS. Although IL-6, IL-8, IL-10, and TNFα serum increased after open abdominal aortic surgery in both groups, fast-track peri-operative management seemed to modulate only IL-6 and IL-10 release. More studies are required to evaluate cytokines as biomarkers to measure outcome.