Systemic inflammatory response in erderly patients following hernioplastical operation

Abstract

The number of old and oldest old patients undergoing surgery of varying severity is increasing. Ageing is a process that changes the performances of most physiological systems and increases susceptibility to diseases and death; accordingly, host responses to surgical stress are altered with ageing and the occurrence of age-related increase in susceptibility to post-operative complications has been claimed. Twenty-four male patients undergoing Lichtenstein (LH) hernioplasty for unilateral inguinal hernia were included in this study and divided in two groups (Young and Old respectively), according to their age. As expression of the acute phase response, we measured changes in concentration of pro-inflammatory cytokines Tumor necrosis factor-alpha and Interleukin-1beta, leukocytes, acute phase proteins C-reactive protein and alpha 1-antitrypsin. Elderly humans showed prolonged and strong inflammatory activity compared to younger subjects in response to surgical stress, indicating that the acute-phase response to surgical stress of elderly humans varies from that of the young, showing initial hyperactivity and a delayed termination of the response. Thus, the acute phase response to surgical stress is higher in old subjects, but the clinical significance of this remains unclear. It is not known whether a causal relationship exists between this stronger acute phase response and the increases in susceptibility to post-operative complications observed in aged patients.

Figure 1

Hernioplasty-caused neutrophilia. Concerning significance between baseline values and post-operative values, in young patients the differences were not significant (ANOVA), whereas in old subjects were significant at all the times (p < 0.001, p < 0.001 and p < 0.01 respectively) (ANOVA). The neutrophilia was significantly higher in old patients, when compared to the young ones, at 6 h and 24 h after the operation (p = 0.02 and p = 0.003 respectively) (t Student's test).

Figure 2

Hernioplasty-caused increase of CRP and AAT values. Concerning AAT, a significant increase of post-operative values respect to baseline ones was observed at 24 h (p < 0.05) and 48 h (p = 0.01 by ANOVA) in young patients, whereas in old subjects they were significant only at 48 h (p < 0.01 by ANOVA). Regarding CRP, in young patients the differences between baseline values and post-operative values were significant only at 24 h (p < 0.05 by ANOVA), whereas in old subjects were significant at 24 (p < 0.05) and 48 hours (p < 0.001 by ANOVA). Besides, the significance was obtained by comparing values of young and old patients at 6 h, 24 h and at 48 h after the operation (p = 0.028, p = 0.05 and p = 0.098 respectively for both by t Student 's test).

Figure 3

Hernioplasty-caused increase of TNF-α and IL-1β values. A significant increase in TNF-α post-operative values in comparison with the baseline ones, was observed only in young subjects at 48 h after the operation (p < 0.05 by ANOVA). In elderly TNF-α values were not significantly higher when compared with baseline values. They were significantly higher in older patients than in younger at 6 h and 24 h after the operation (p = 0.003 and p= 0.047, respectively by t Student's test). A significant increase of IL-1β post-operative values respect to baseline values was observed only in old patients at 6 h (p < 0.01 by ANOVA) and IL-1β values were significantly higher in older patients than in younger at 6 h after the operation (p = 0.002 by t Student's test).