Effects of surgery start time on postoperative cortisol, inflammatory cytokines, and postoperative hospital day in hip surgery: Randomized controlled trial

48 patients scheduled for a hip hemiarthroplasty or total hip replacement were randomized to receive said surgery beginning in the morning (8AM) or the afternoon (1-2PM). The primary outcomes of interest were the levels of cortisol, interleukin-6 (IL-6) and interleukin-8 (IL-8). Secondary outcomes of interest included pain on a Visual Analog Scale (VAS) and the length of hospitalization. Follow up was performed up to 48 hours post-operation. Results revealed significantly higher levels of cortisol at 24 and 48 hours, IL-6 at 12, 24 and 48 hours, and IL-8 at 12 and 24 hours in the morning group compared to the afternoon group. Similarly, the proportion of patients who returned to initial cortisol levels was significantly lower in the morning group at both 24 and 48 hours. No significant differences were observed in VAS pain scores, length of hospitalization, or the number of patients with a hospitalization stay of at least 3 weeks.