Systemic response to surgery

The direct traumatic injury of surgery initiates a chain of physiological events via the endocrine, metabolic, cardiovascular and immune systems. The unregulated stress response can lead to systemic inflammatory response syndrome (SIRS), but if the response was totally obliterated then this would predispose to infection and failure of the recovery process. To an extent this response is protective. This article outlines the components of the interlinked endocrine, metabolic, immune and haemodynamic responses and discusses the ways in which the various components of the response can be modified in order to optimise postoperative recovery and to reduce complications. The role of vitamin supplementation and the controversial element of glucocorticoids is also discussed.