The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty
Abstract Background Increasing evidence shows that postoperative innate immune dysregulation is associated with delayed recovery and infectious complications. The aim of this study was to compare the effects of general versus spinal anesthesia on innate immune function during and after total hip art...
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BMC
2025-01-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02883-1 |
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| author | Lotte M. C. Jacobs Veerle Bijkerk Lucas T. van Eijk Leo A. B. Joosten Christiaan Keijzer Jetze Visser Michiel C. Warlé |
| author_facet | Lotte M. C. Jacobs Veerle Bijkerk Lucas T. van Eijk Leo A. B. Joosten Christiaan Keijzer Jetze Visser Michiel C. Warlé |
| author_sort | Lotte M. C. Jacobs |
| collection | DOAJ |
| description | Abstract Background Increasing evidence shows that postoperative innate immune dysregulation is associated with delayed recovery and infectious complications. The aim of this study was to compare the effects of general versus spinal anesthesia on innate immune function during and after total hip arthroplasty (THA). Methods This comparative matched cohort study used data from two single-center randomized-controlled trials. Patients from the control group of the HIPPO study received general anesthesia and were matched to control patients from the MAGIC study who received spinal anesthesia in a 2:1 ratio (general(n = 18); spinal(n = 9)). Immune function was assessed by determination of ex vivo cytokine production capacity upon whole blood stimulation with E. coli lipopolysaccharides (LPS) and measurement of plasma cytokines and danger-associated molecular patterns (DAMPs). Results In the general anesthesia group, ex vivo cytokine production capacity of IL-1β was significantly lower shortly after induction (p = 0.02) and both IL-1β and IL-6 were significantly lower at the end of surgery compared to the spinal anesthesia group (p = 0.002 and p = 0.02, respectively). On postoperative day 1 (POD1), no differences were observed. Plasma cytokine concentrations did not differ between the spinal and general anesthesia group at most timepoints, except for IL-10 at the end of surgery (p = 0.04) and TNF on POD1 (p = 0.04), which were higher in the general anesthesia group. Plasma concentrations of DAMPs did not differ between the groups. Conclusions General anesthesia has a transient impact on innate immune function in patients undergoing THA, but the clinical significance of anesthesia-induced innate immune dysregulation might be limited as no differences were observed on POD1. Trial registration The HIPPO study (NCT05562999, date of registration 2022-10-03) and MAGIC study (NCT05723406, date of registration 2023-02-10) are registered at ClinicalTrials.gov. |
| format | Article |
| id | doaj-art-3f932bcf6d474fdaa87b4e01c4f26f11 |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-3f932bcf6d474fdaa87b4e01c4f26f112025-01-12T12:37:07ZengBMCBMC Anesthesiology1471-22532025-01-012511910.1186/s12871-024-02883-1The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplastyLotte M. C. Jacobs0Veerle Bijkerk1Lucas T. van Eijk2Leo A. B. Joosten3Christiaan Keijzer4Jetze Visser5Michiel C. Warlé6Department of Surgery, Radboud University Medical CenterDepartment of Surgery, Radboud University Medical CenterDepartment of Anesthesiology, Radboud University Medical CenterDepartment of Internal Medicine, Radboud University Medical CenterDepartment of Anesthesiology, Radboud University Medical CenterDepartment of Orthopedics, Radboud University Medical CenterDepartment of Surgery, Radboud University Medical CenterAbstract Background Increasing evidence shows that postoperative innate immune dysregulation is associated with delayed recovery and infectious complications. The aim of this study was to compare the effects of general versus spinal anesthesia on innate immune function during and after total hip arthroplasty (THA). Methods This comparative matched cohort study used data from two single-center randomized-controlled trials. Patients from the control group of the HIPPO study received general anesthesia and were matched to control patients from the MAGIC study who received spinal anesthesia in a 2:1 ratio (general(n = 18); spinal(n = 9)). Immune function was assessed by determination of ex vivo cytokine production capacity upon whole blood stimulation with E. coli lipopolysaccharides (LPS) and measurement of plasma cytokines and danger-associated molecular patterns (DAMPs). Results In the general anesthesia group, ex vivo cytokine production capacity of IL-1β was significantly lower shortly after induction (p = 0.02) and both IL-1β and IL-6 were significantly lower at the end of surgery compared to the spinal anesthesia group (p = 0.002 and p = 0.02, respectively). On postoperative day 1 (POD1), no differences were observed. Plasma cytokine concentrations did not differ between the spinal and general anesthesia group at most timepoints, except for IL-10 at the end of surgery (p = 0.04) and TNF on POD1 (p = 0.04), which were higher in the general anesthesia group. Plasma concentrations of DAMPs did not differ between the groups. Conclusions General anesthesia has a transient impact on innate immune function in patients undergoing THA, but the clinical significance of anesthesia-induced innate immune dysregulation might be limited as no differences were observed on POD1. Trial registration The HIPPO study (NCT05562999, date of registration 2022-10-03) and MAGIC study (NCT05723406, date of registration 2023-02-10) are registered at ClinicalTrials.gov.https://doi.org/10.1186/s12871-024-02883-1AnesthesiaTotal hip arthroplastyInnate immune function |
| spellingShingle | Lotte M. C. Jacobs Veerle Bijkerk Lucas T. van Eijk Leo A. B. Joosten Christiaan Keijzer Jetze Visser Michiel C. Warlé The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty BMC Anesthesiology Anesthesia Total hip arthroplasty Innate immune function |
| title | The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| title_full | The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| title_fullStr | The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| title_full_unstemmed | The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| title_short | The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| title_sort | effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty |
| topic | Anesthesia Total hip arthroplasty Innate immune function |
| url | https://doi.org/10.1186/s12871-024-02883-1 |
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