Thurs., 10/18/07 Polytrauma, Paper #9, 2:27 pm OTA-2007
Assessment of Systemic Proinflammatory Mediator Release following Skeletal Surgery: A Prospective Cohort Study
Christopher Tzioupis, MD1 (n); Ivan Tarkin, MD1 (n); Philipp Kobbe, MD1 (n);
Mohamad K. Allami, MD3 (n); Kirsten Sommer, MD2 (n); Martin van Griensven, MD3 (n); Christian Krettek, MD2 (n); Peter V. Giannoudis, MD4 (n); Hans-Christoph Pape, MD1 (n);
1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
2Department of Trauma Surgery, Hannover Medical School, Hannover, Germany;
3Ludwig Boltzmann Institute for Experimental Surgery, Vienna, Austria;
4Department of Trauma Surgery, St. James’s University Hospital, Leeds, United Kingdom
Purpose: Patients who face major elective surgeries usually undergo a preoperative work-up regarding the risk of the procedure. Proinflammatory cytokines have been advocated as adjunct tools to assess a surgical stimulus with Interleukin-6 (IL-6) being the most reliable parameter. We investigated whether the systemic levels of IL-6 are able to distinguish between the magnitude of surgical stress exerted by several nonemergent surgeries.
Patients and Methods: The setting of this clinical, prospective cohort study was three Level I trauma centers. Inclusion criteria were blunt trauma; age 16 to 75 years; and only one surgery at the time of proinflammatory cytokine measurement. Serial blood samples were obtained at baseline, 24, and 72 hours. The three main groups were PAF (open reduction and internal fixation [ORIF] for isolated pelvic and acetabular fractures); group SF (ORIF for isolated spinal fractures); and group FF (intramedullary nailing for isolated femoral shaft fractures). Two proinflammatory cytokines, IL-6 and IL-8, were measured by enzyme-linked immunosorbant assays. Approaches for pelvic and acetabular fractures were: 8 anterior, 11 posterior, and 2 combined; spinal fractures: 8 ventral (cervical), 15 dorsal (cervical and thoracic), and 1 combined approach. The mean time of surgery for pelvic and acetabular fractures was 181 minutes (range, 92-370), for spinal trauma was 147 minutes (range, 83-240), and that for isolated femoral fracture fixation was 62 minutes (range, 42-86). Statistical analysis, using two-way analysis of variance and post hoc test, was performed.
Results: ORIF for isolated pelvic and acetabulum, spine, and femoral shaft fractures caused comparable increases in perioperative cytokine concentrations with polytrauma cases. The highest concentrations of proinflammatory cytokines were evident in femoral and pelvic fractures, with significant differences when compared with cervical spine injuries at 24 hours. Comparable results were found for IL-8.
Conclusion: The release of markers appeared to be related to the magnitude of surgery (extensile approach) rather than to the duration of the procedure. The high increase at 24 hours in group PAF was associated with the degree of blood loss. This study supports the value of measuring proinflammatory cytokines in determining the surgical burden after truncal and lower extremity skeletal surgery.
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