gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

25.10. - 28.10.2016, Berlin

Perioperative inflammatory response in major surgery – do geriatric patients behave differently?

Meeting Abstract

  • presenting/speaker Mathias Thaeter - Universitätsklinik der RWTH Aachen, Klinik für Unfallchirurgie und Wiederherstellungschirurgie, Aachen, Germany
  • Matthias Knobe - Universitätsklinik und Poliklinik der RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany
  • Michiel Vande Kerckhove - Universitätsklinik und Poliklinik der RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany
  • Franziska Böhle - Universitätsklinik der RWTH Aachen, Klinik für Unfallchirurgie und Wiederherstellungschirurgie, Aachen, Germany
  • Eddy Verhaven - St. Nikolaus-Hospital Eupen, Klinik für Orthopädie, Eupen, Belgium
  • Hans-Christoph Pape - Universitäts- und Poliklinik der RWTH Aachen, Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Aachen, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocPO28-1281

doi: 10.3205/16dkou770, urn:nbn:de:0183-16dkou7709

Veröffentlicht: 10. Oktober 2016

© 2016 Thaeter et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Introduction: Cytokines are a central regulator of the inflammatory response after trauma, surgery or critical illness. Interleukin 6 (IL-6) as a mainly proinflammatory interleukin, especially influences the duration and amplitude of systemic inflammatory responses significantly. The IL-6 serum concentration correlates with injury severity, the extent of tissue trauma and has negative impact on prognosis. It appears to be a promising determinator for scheduling time and extent of secondary surgery after polytrauma to avoid immunoparesis, especially in the elderly. Despite growing interest the immunological relevance of individual surgery strategies has not been resolved. The aim of this study is the quantification of IL-6 levels in patients with traumatic fractures of the spine and the proximal femur during surgical care.

Methods: Methods: Data were collected at a level-1 university trauma center in a prospective, controlled, non-randomized cohort study. IL-6 levels were analyzed via ELISA from repetitively collected venous blood samples from 25 patients with unstable fractures of the thoracic or lumbar spine (SP: m/w 14/11, age 49 yrs. ± 20 (SD)) and 16 patients with traumatic fracture oft the proximal femur (PF: m/w 8/8, age 73 yrs. ± 16). 4 patients with isolated traumatic calcaneal fracture (TC: m/w 4/0, age 40 yrs. ± 10) served as a control group. Surgical treatment was performed using minimal-invasive posterior instrumentation (SP) or by DHS (n = 7), gamma nail (n = 5) and PCCP (n = 4) (PF). In addition, demographic and clinical data, such as ventilation time, hospital stay and mortality were collected.

Results: Group PF group showed higher posttraumatic IL-6 concentrations (47.56 ± 3.74 (SDM) pg/ml vs. 12.40 ± 1.62 pg/ml). Surgical treatment was followed by a significant increase of IL-6 levels in both groups (SP: 21.16 ± 6.01 (SDM) pg/ml (p = 0.028) 4 hrs. post-op., 27.67 ± 7.42 pg/ml (p = 0.003) 24 hrs. post-op.; PF: 50.52 ± 10.62 pg/ml (p = 0.028) 4 hrs. post-op., 36.38 ± 10.83pg/ml (p = 0.028) 24 hrs. post-op.). Concentration profiles were similar in both groups, but increase was significantly higher (p = 0.013) in the PF group 4 hours after surgery. No significant increase of IL-6 levels to baseline was detectable 48 hours after surgery.

Conclusion: Both trauma and operative treatment of fractures of the proximal femur and the spine lead to measurable increase of IL-6 levels. In view of a comparative surgical burden, these data suggest that age may not be a confounding factor for a surgery induced inflammatory response.