Abstract
Background
Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic cholecystectomy, LC) and major abdominal surgery (MAS) and if these changes correlated with postoperative subjective recovery measures.
Methods
We examined 76 and 44 patients undergoing LC and MAS, respectively, for 4 days before and after surgery. Subjective recovery parameters were assessed by visual analogue scale (sleep quality, general well-being and pain) and fatigue was measured by a ten-point fatigue scale. The activity levels of the patients were monitored by actigraphy (a wrist-worn device measuring patient activity). Measures of circadian activity level [interday stability (IS), intraday variability (IV) and the amplitude (AMP)] were derived after nonparametric analysis of activity data.
Results
IS was significantly reduced both after MAS (0.72 before surgery and 0.58 after surgery, p < 0.0001) and after LC (0.76 before surgery and 0.66 after surgery, p < 0.0001). The IS dropped significantly more following MAS surgery compared with following LC surgery (p < 0.001). The fragmentation of the rhythm IV increased and the amplitude dropped significantly after both LC and MAS surgery. Subjective recovery parameters were worse after MAS when compared with LC, and correlated significantly to the circadian activity parameters (IS, IV and AMP).
Conclusion
Severely disturbed circadian activity parameters was found after both LC and MAS with worse changes after MAS. Measures of circadian activity pattern analyses correlated significantly with postoperative subjective recovery parameters.
Similar content being viewed by others
References
Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA (1997) Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 79:1512–1516
Belcaro G, Nicolaides AN, Geroulakos G, Artese L, Laurora G, Cesarone MR, de Sanctis MT, Incandela L, Ricci A, Ramaswami G, Willows L (1997) Circadian pattern of post-surgical fatal pulmonary embolism. Vasa 26:287–290
Marsch SC, Schaefer HG, Skarvan K, Castelli I, Scheidegger D (1992) Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Anesthesiology 76:518–527
Rosenberg J, Pedersen MH, Ramsing T, Kehlet H (1992) Circadian variation in unexpected postoperative death. Br J Surg 79:1300–1302
Debon R, Chassard D, Duflo F, Boselli E, Bryssine B, Allaouchiche B (2002) Chronobiology of epidural ropivacaine: variations in the duration of action related to the hour of administration. Anesthesiology 96:542–545
Cheeseman JF, Merry AF, Pawley MDM, de Souza RL, Warman GR (2007) The effect of time of day on the duration of neuromuscular blockade elicited by rocuronium. Anaesthesia 62:1114–1120
Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392
Van Someren EJ (2007) Improving actigraphic sleep estimates in insomnia and dementia: how many nights? J Sleep Res 16:269–275
Carvalho-Bos SS, Riemersma-van der Lek RF, Waterhouse J, Reilly T, Van Someren EJ (2007) Strong association of the rest-activity rhythm with well-being in demented elderly women. Am J Geriatr Psychiatry 15:92–100
Mormont MC, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan A, Lellouch J, Misset JL, Touitou Y, Levi F (2000) Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res 6:3038–3045
Rich T, Innominato PF, Boerner J, Mormont MC, Iacobelli S, Baron B, Jasmin C, Levi F (2005) Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res 11:1757–1764
Bisgaard T, Kjaersgaard M, Bernhard A, Kehlet H, Rosenberg J (1999) Computerized monitoring of physical activity and sleep in postoperative abdominal surgery patients. J Clin Monit Comput 15:1–8
Zutshi M, Delaney CP, Senagore AJ, Fazio VW (2004) Shorter hospital stay associated with fastrack postoperative care pathways and laparoscopic intestinal resection are not associated with increased physical activity. Colorectal Dis 6:477–480
Bisgaard TF, Kristiansen VB, Hjortso NC, Jacobsen LS, Rosenberg J, Kehlet H (2004) Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. Br J Surg 91:151–158
Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC (1992) Automatic sleep/wake identification from wrist activity. Sleep 15:461–469
Hatfield CF, Herbert J, Van Someren EJ, Hodges JR, Hastings MH (2004) Disrupted daily activity/rest cycles in relation to daily cortisol rhythms of home-dwelling patients with early Alzheimer’s dementia. Brain 127:1061–1074
Scherder EJ, Van Someren EJ, Swaab DF (1999) Transcutaneous electrical nerve stimulation (TENS) improves the rest-activity rhythm in midstage Alzheimer’s disease. Behav Brain Res 101:105–107
Christensen T, Bendix T, Kehlet H (1982) Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg 69:417–419
Gögenur I, Middleton B, Burgdorf S, Rasmussen LS, Skene DJ, Rosenberg J (2007) Impact of sleep and circadian disturbances in urinary 6-sulphatoxymelatonin levels, on cognitive function after major surgery. J Pineal Res 43:179–184
Bisgaard T, Klarskov B, Kehlet H, Rosenberg J (2002) Recovery after uncomplicated laparoscopic cholecystectomy. Surgery 132:817–825
Gögenur I, Rosenberg-Adamsen S, Kiil C, Kjaersgaard M, Kehlet H, Rosenberg J (2001) Laparoscopic cholecystectomy causes less sleep disturbance than open abdominal surgery. Surg Endosc 15:1452–1455
Van Someren EJ, Riemersma-van der Lek RF (2007) Live to the rhythm, slave to the rhythm. Sleep Med Rev 11:465–484
Youngstedt SD, Kripke DF, Elliott JA, Klauber MR (2001) Circadian abnormalities in older adults. J Pineal Res 31:264–722
Middleton B, Stone BM, Arendt J (2002) Human circadian phase in 12:12 h, 200: <8 lux and 1000: <8 lux light-dark cycles, without scheduled sleep or activity. Neurosci Lett 329:41–44
Middleton B, Arendt J, Stone BM (1996) Human circadian rhythms in constant dim light (8 lux) with knowledge of clock time. J Sleep Res 5:69–76
Miyazaki T, Kuwano H, Kato H, Ando H, Kimura H, Inose T, Ohno T, Suzuki M, Nakajima M, Manda R, Fukuchi M, Tsukada K (2003) Correlation between serum melatonin circadian rhythm and intensive care unit psychosis after thoracic esophagectomy. Surgery 133:662–668
Rasmussen LS, O’Brien JT, Silverstein JH, Johnson TW, Siersma VD, Canet J, Jolles J, Hanning CD, Kuipers HM, Abildstrom H, Papaioannou A, Raeder J, Yli-Hankala A, Sneyd JR, Munoz L, Moller JT (2005) Is peri-operative cortisol secretion related to post-operative cognitive dysfunction? Acta Anaesthesiol Scand 49:1225–1231
Acknowledgements
The authors would like to acknowledge a grant from the University of Copenhagen, Denmark and the Danish Medical Research Council (Jr no. 22-04-0430).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gögenur, I., Bisgaard, T., Burgdorf, S. et al. Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery. Surg Endosc 23, 1026–1031 (2009). https://doi.org/10.1007/s00464-008-0112-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0112-9