Overview
The population older than 80 years will significantly increase in the near future. Older patients' cognitive and physical status is known to deteriorate after surgery, leading to a high 30-day mortality due to post-operative comorbidities. Aging and related diseases share immune-related pathomechanisms. During aging, a chronic, low-grade sterile inflammation, called inflamaging, gradually develops. This likely results from low-grade innate immune activation and a functional, epigenomic and transcriptomic reprogramming of immune cells. Based on the hypothesis that surgical trauma leads to misplaced or altered self-molecules, which exacerbate inflammation and the postoperative risk for morbidity and mortality in elderly patients. There is increasing evidence that the individual's pre-operative immunobiography determines the susceptibility to peri-operative inflammation and post-operative outcome. Current exploratory pilot study will thus perform phenotyping of patients above 80 years undergoing major surgery. Participants will be evaluated for acute and long-term outcomes, including all-cause mortality, physical and cognitive function. To assess the individual's immunobiography, participants will be characterised by inflammation biomarkers combined with immunophenotyping, functional assays, and (epi-) genomic analyses before and after surgery. The cognitive impairment will be evaluated by measuring markers of neurodegeneration and neuropsychiatric testing and relate findings to volumetric imaging using high-resolution MRI to identify brain changes associated with cognitive decline.
Eligibility
Inclusion Criteria:
- age ≥ 80 years
- elective major surgery defined as knee / hip replacement, spondylodesis (> 2 levels), gastrectomy, resection of esophagus, liver, pancreas, colon, rectum or lung
Exclusion Criteria:
- no informed consent
- not able to perform neurocognitive testing
- preexisting infection systemic: CRP>100 mg/l, Leukos >12.0 G/l or clinical signs
Prosthetic joint infection (MSIS 2011 criteria):
PJI is present when 1 major criteria exist or 4 out of 6 minor criteria exist
Major criteria:
- 2 positive periprosthetic cultures with phenotypically identical organisms
- A sinus tract communicating with the joint
Minor criteria:
- Elevated CRP and ESR
- Elevated synovial fluid WBC count or ++ change on leukocyte esterase test strip
- Elevated synovial fluid PMN%
- Presence of purulence in the affected joint
- Positive histologic analysis of periprosthetic tissue
- A single positive culture
- Immunosuppression (HIV, glucocorticoids, immunosupressants)
- Autoimmune diseases
- ongoing or recent (<3 months) chemo/radiotherapy