Effects of Anesthesia Type on Inflammatory Response

Tokat Gaziosmanpasa University849 enrolled

Overview

In total knee arthroplasty, surgical and anesthetic procedures can lead to a significant increase in systemic inflammation. This procedure is frequently performed under either general or spinal anesthesia. However, studies investigating the effect of anesthesia type on systemic inflammation have shown conflicting results. The Systemic Inflammatory Response Index (SIRI) and the Systemic Immune-Inflammation Index (SII) provide important information about the extent of systemic inflammation. This study aimed to investigate the effects of general and spinal anesthesia on perioperative changes in SII and SIRI during total knee arthroplasty. Between January 2020 and April 2025, data from 849 patients who underwent total knee arthroplasty were retrospectively reviewed. Patients received either spinal anesthesia (Group S) or general anesthesia (Group G). The groups were compared in terms of changes in perioperative SII and SIRI (ΔSII and ΔSIRI), total opioid consumption, postoperative complications, and length of hospital stay.

Study Type

OBSERVATIONAL

Enrollment

849

Conditions

Spinal Aneshtesia General Anesthetic Inflammation Neutrophils Total Knee Arthroplasty White Blood Cells

Interventions

The effects of the groups on perioperative inflammation changes were compared.OTHER

Between January 2020 and April 2025, data from 849 patients who underwent total knee arthroplasty were retrospectively reviewed. Preoperative hemogram values were obtained during routine anesthesia clinic evaluation, typically one day prior to surgery. Postoperative hemogram samples were collected on the day of surgery (postoperative day 0), within 4 to 12 hours after the procedure. Blood parameters included neutrophil, lymphocyte, monocyte, and platelet counts. Based on these values, inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) were calculated.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged 18 to 75 years * Patients with ASA physical status I or II * Patients who have underwent total knee arthroplasty under general or spinal anesthesia Exclusion Criteria: * Patients with BMI ≥40 kg/m2 * Patients with ASA physical status ≥III * Patients with severe cardiopulmonary or metabolic disorders, coagulation disorders or active infection * Patients with known allergies or chronic steroid use * Patients with incomplete laboratory data * Patients who underwent revision total knee arthroplasty * Patients who required intraoperative conversion from spinal to general anesthesia * Patients with a history of major trauma and/or emergency surgery

Outcomes

Primary Outcomes

Systemic immune inflammation index (SII) and systemic inflammatory response index (SIRI)

SII = neutrophil X platelet / lymphocyte count and the SIRI = neutrophil X monocyte / lymphocyte count

Time frame: Preoperative hemogram values were obtained during routine anesthesia clinic evaluation, typically one day prior to surgery. Postoperative hemogram samples were collected on the day of surgery (postoperative day 0), within 4 to 12 hours after the procedur

Secondary Outcomes

Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR)

NLR = neutrophil / lymphocyte and PLR= platelet / lymphocyte

Total amount of opioids consumed postoperatively

Total opioid consumption was calculated by converting all opioid doses to morphine milligram equivalents

Time frame: Total amount of opioids requirement within the first 24 postoperative hours