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

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 48hours (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 48h 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; 48h, 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 48h after surgery (P =. 015; P =. 005; P =. 002), and in IL-8 levels at 12 and 24h 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.