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

Introduction: The aim of this study was to determine the incidence of systemic inflammatory response syndrome (SIRS) and cytokines release in patients after open abdominal aortic surgerywith fast-track compared to those with conventional peri-operative management. Material and methods: A 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 2 hours 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 (TNF alpha, IL-1 beta, IL-6, IL-8, IL-10, and IL-12p70) were analysed at baseline, 8, 24, and 48 hours, post-operatively. The SIRS incidence was recorded in the first72 hours after surgery, as well as the mortality and complications rate during admission. Results: A 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 +/- 14.34 min( 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 72 h postoperatively, respectively. As regards serum cytokines, a higher release of IL-6, IL-8, IL-10 and TNF alpha in GC was observed compared to GFT. At 8 h, IL-6 reached a statistically significant increase compared to baseline in GC( P = .045). At 24 h, 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). Conclusions: Open abdominal aortic surgery showed a high incidence of SIRS. Although IL-6, IL-8, IL-10, and TNF alpha 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 studiesare required to evaluate cytokines as biomarkers to measure outcome. (C) 2018 SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.