Endovascular repair of abdominal aortic aneurysm reduces intraoperative cortisol and perioperative morbidity.
BACKGROUND
The release of catabolic stress hormones because of surgical trauma leads to a breakdown of fats, proteins, and carbohydrate stores and interference with immune function. This can delay wound healing and may increase the risk of systemic inflammatory response syndrome (SIRS)/sepsis and postoperative complications. Minimally invasive surgery can attenuate this response. Our purpose was (1) to compare neuroendocrine responses in patients undergoing open abdominal aneurysm repair with those in patients undergoing endovascular aneurysm repair (EVAR), (2) to compare the incidence of SIRS/sepsis and all complications in these two groups, and (3) to look at the relationship between procedure type, neuroendocrine response, and incidence of SIRS/sepsis and complications.


METHODS
Forty-six patients who underwent open repair and 19 who underwent EVAR were studied. A baseline (T1) 24-hour urine save was undertaken in the week before admission, and a second 24-hour save (T2) commenced at anesthetic induction to measure cortisol and catecholamines. The incidences of SIRS/sepsis and complications were recorded.


RESULTS
Significant ( P </= .001) increases in cortisol and adrenaline from T1 to T2 occurred in all patients. Controlling for the type of anesthetic, the administration of exogenous inotropes, and beta-adrenoreceptor antagonists (beta-blockers), there was a significant difference in cortisol (T2) associated with the type of procedure. Responses were greater in open patients in comparison to EVAR patients (F 3,61 = 5.0; P = .03). The incidence of SIRS (50% vs 32%), sepsis (26% vs 5%), and all complications (76% vs 32%) was significantly ( P </= .02) higher in open than EVAR patients, respectively. Cortisol and adrenaline measured for 24 hours, commencing at the time of induction, tended to be higher in patients with SIRS/sepsis and all complications, but this did not reach significance.


CONCLUSIONS
An attenuated glucocorticoid surge characterizes the reduced stress response experienced by patients undergoing EVAR compared with open abdominal aortic aneurysm repair. A reduction in the occurrence of SIRS is a feature of a more favorable postoperative course after an endovascular approach.
Pearson
Sue
S
Division of Health Sciences, The University of South Australia, Adelaide. sue.pearson@unisa.edu.au
Hassen
Tiffany
T
Spark
J Ian
JI
Cabot
John
J
Cowled
Prue
P
Fitridge
Robert
R
D000368:Aged; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002395:Catecholamines / Q000652:urine; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007432:Intraoperative Period; D008297:Male; D009017:Morbidity; D011446:Prospective Studies; D013312:Stress, Physiological / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D014656:Vascular Surgical Procedures / Q000009:adverse effects
D002395:Catecholamines; D006854:Hydrocortisone; D004837:Epinephrine