The cortisol stress response induced by surgery: A systematic review and meta-analysis
Author(s)
Type
Journal Article
Abstract
Objective
Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined.
Design
We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters.
Methods
We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in meta-analysis and plotted over time.
Results
We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, women and patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response.
Conclusions
The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response.
Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined.
Design
We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters.
Methods
We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in meta-analysis and plotted over time.
Results
We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, women and patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response.
Conclusions
The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response.
Date Issued
2018-11-01
Date Acceptance
2018-07-17
Citation
Clinical Endocrinology, 2018, 89 (5), pp.554-567
ISSN
0300-0664
Publisher
Wiley
Start Page
554
End Page
567
Journal / Book Title
Clinical Endocrinology
Volume
89
Issue
5
Copyright Statement
© 2018 John Wiley & Sons Ltd.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30047158
Subjects
adrenal cortex
adrenal insufficiency
CORTICOSTEROID-BINDING GLOBULIN
cortisol
DOSE FENTANYL ANESTHESIA
ENDOCRINE RESPONSE
Endocrinology & Metabolism
hydrocortisone
INFLAMMATORY RESPONSES
Life Sciences & Biomedicine
PITUITARY-ADRENAL FUNCTION
pituitary-adrenal system
PLASMA ADRENOCORTICOTROPIN
POSTOPERATIVE PERIOD
Science & Technology
SERUM-FREE CORTISOL
stress
surgery
SURGICAL TRAUMA
TOTAL HIP-REPLACEMENT
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2026-07-26