Impact of Perioperative Circadian Rhythm Disruption on Recovery and Complications in Skull Base Surgery: A Prospective Cohort Study.

BACKGROUND

Perioperative disruption of circadian rhythm has been implicated in adverse surgical outcomes, but its relationship to recovery and complications in patients undergoing skull base surgery remains uncertain. This prospective cohort study investigates the extent of perioperative circadian disruption, its physiological markers, and its associations with recovery trajectories and postoperative complications.

MATERIALS AND

METHODS

Eighty-two adult patients scheduled for elective skull base tumor resection were enrolled. Serial measurements of serum melatonin and cortisol were obtained preoperatively and on postoperative days 1, 3, and 7. Sleep quality (Pittsburgh Sleep Quality Index), pain scores, and postoperative complications were recorded. Patients were categorized by the degree of combined melatonin and cortisol rhythm disruption. Statistical comparisons between high and low disruption groups were performed for clinical outcomes, complications, and recovery.

RESULTS

Significant perioperative suppression of melatonin and elevation of cortisol were observed postoperatively, with a gradual trend toward baseline by day 7. Mean (SD) melatonin fell from 42.4 (18.0) pg/mL preoperatively to 19.2 (9.9) pg/mL on day 1 ( p  < 0.001), while cortisol rose from 14.5 (3.0) to 25.4 (5.7) μg/dL ( p  < 0.001). Sleep scores worsened (mean rising from 6.2 to 14.9, p  < 0.001), and the length of stay averaged 7.9 ± 3.0 days. Overall, 48.8% had postoperative complications, with CSF leak (23.2%), infection (14.6%), and neurological deficits (11.0%). Patients in the highest circadian disruption group had significantly higher overall complications (73.9% vs. 39.0%, p  = 0.042), longer hospital stay (8.0 vs. 7.9 days, p  = 0.018), and poorer sleep recovery.

CONCLUSION

Perioperative circadian disruption, quantified by hormonal and sleep indices, is frequent and strongly associated with adverse outcomes following skull base surgery. Strategies to preserve circadian alignment perioperatively could improve recovery and reduce complications.