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To evaluate the inflammatory response of participants who will undergo unilateral inguinal hernia surgery at two different times of the day (08.00-12.00 during the day and 18.00-22.00 at night). The main question it aims to answer is; Is the inflammation response higher in participants who undergo surgery later in the day? Serum inflammatory parameters will be measured in both groups at the preoperative 1st hour and the postoperative 24th hour.
Participants who would undergo unilateral inguinal herniography surgery at different times during the day were determined into two groups: day (08.00-12.00) and night (18.00-22.00). The Athens Insomnia Scale (AIS) will be asked verbally on the first preoperative day to determine the participants' preoperative circadian rhythm adaptation and sleep status. Serum inflammatory parameters of both participant groups will be measured and recorded at the preoperative 1st hour and the postoperative 24th hour. A laryngeal mask will be applied to the participants after induction with 2-3 mg/kg propofol and 1mg/kg fentanyl, as in routine anesthesia practice. Anesthesia maintenance will be provided with sevoflurane and 0.05-0.2 mcg/kg/min remifentanil infusion. Participants' age, gender, weight, height, BMI (body mass index), comorbidities, medications used, surgeries, ASA (American society of anesthesiologists) scoring, preoperative AIS (Athens insomnia scale) score, and preoperative laboratory data will be recorded. At the same time, participants' postoperative hospital stay, resting and moving NRS (Numeric rating scale) scores at the 24th postoperative hour, and recovery quality (Qor-15 score) from anesthesia will be recorded.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Day Group | Active Comparator | Participants who underwent inguinal herniography operation between 08.00-12.00 |
|
| Night Group | Active Comparator | Participants who underwent inguinal herniography operation between 18.00-22.00 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Day Group | Procedure | Patient group that will be operated on between 08.00-12.00 |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change of IL6 (interleukin6) (ng/ml) | IL6 (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation and trauma that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of recovery from anesthesia according to difference in circadian rhythm | The quality of recovery-15 (QoR-15) is a patient-reported outcome measurement measuring QoR after surgery and anesthesia. The scale is arbitrary and ranges from 0 to 150. Higher results mean better build quality. | Postoperative 24th hour |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Rating Scale (NRS) | NRS is a scale that uses 11 numbers (between 0 and 10) to measure pain intensity. 0: no pain 10: unbearable pain | Postoperative 24th hour |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Bilkent City Hospital | Ankara | CANKAYA | 06800 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42154167 | Derived | Dikmen Demiryorgan B, Nalbant B, Demiryorgan F, Kavak Akelma F. The effect of unilateral inguinal hernia surgery performed at different times of the day on inflammation and recovery: a prospective randomized controlled study. Updates Surg. 2026 May 19. doi: 10.1007/s13304-026-02669-9. Online ahead of print. |
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| Night Group |
| Procedure |
Patient group that will be operated on between 18.00-22.00 |
|
| Change of NLR ( Neutrophil/ Lymphocyte Ratio ) |
NLR (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. |
| Postoperative 24th hour |
| Change of PLR ( Platelet / Lymphocyte Ratio ) | PLR (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of SII (Systemic immune-inflammation index ) | SII (Neutrophil × Platelet/ Lymphocyte) (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of CRP (C Reactive Protein) (mg/dl) | CRP (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of Fibrinogen (mg) | Fibrinogen (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of Sedimentation (mm/hour) | Sedimentation (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of Procalcitonin (µg/l) | Procalcitonin (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |
| Change of Ferritin (ml/ng) | Ferritin (one of the inflammatory parameters, compared to baseline according to circadian rhythm) is a validated parameter that shows the severity of inflammation that can be measured in serum. Change = (postoperative 24th hour - preoperative 1st hour) higher difference means more inflammatory response. | Postoperative 24th hour |