HormonesMelatonin

Perioperative circadian rhythm disruption is associated with adverse outcomes following skull base surgery

This prospective cohort study of 82 patients undergoing skull base tumor resection found significant perioperative disruption of circadian rhythms, marked by suppressed melatonin and elevated cortisol, which was associated with higher complication rates and longer hospital stays. Patients with the highest circadian disruption had significantly more overall complications (73.9% vs. 39.0%, p=0.042) and longer hospital stay (8.0 vs. 7.9 days, p=0.018).

Last updated: Aug 15, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score32/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Impact of Perioperative Circadian Rhythm Disruption on Recovery and Complications in Skull Base Surgery: A Prospective Cohort Study.

observational

Gupta K, Singh S, Gupta K · Asian journal of neurosurgery (2026)

Participants: N/A
Duration: 7 days postoperative
Intervention: Observation of perioperative circadian rhythm disruption (no intervention)
Outcome: Postoperative complications, length of hospital stay, sleep quality (PSQI), melatonin and cortisol levels
Effect Size: N/A
Population: Adults undergoing elective skull base tumor resection

Result:

PubMed: 42535145DOI: 10.1055/s-0046-1819645

Mechanism Graph

Surgical stress causes suppression of melatonin and elevation of cortisol
↓
Disruption of circadian rhythms leads to poorer sleep quality
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Impaired recovery and increased susceptibility to complications
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Result: Higher complication rates and longer hospital stay

Limitations

  • ⚠Observational design cannot establish causality
  • ⚠Single-center study may limit generalizability
  • ⚠Potential confounding factors not fully controlled

Frequently Asked Questions

What is the main finding of this study?▼

Perioperative circadian disruption, measured by melatonin and cortisol changes, is common and associated with worse outcomes after skull base surgery.

How was circadian disruption measured?▼

Serum melatonin and cortisol were measured preoperatively and on postoperative days 1, 3, and 7, along with sleep quality using the Pittsburgh Sleep Quality Index.

What were the complication rates?▼

Overall, 48.8% had postoperative complications, with CSF leak (23.2%), infection (14.6%), and neurological deficits (11.0%).

Could preserving circadian rhythm improve outcomes?▼

The authors suggest that strategies to preserve circadian alignment perioperatively could improve recovery and reduce complications, but this needs further testing.

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References

  1. 1.Gupta K, Singh S, Gupta K. "Impact of Perioperative Circadian Rhythm Disruption on Recovery and Complications in Skull Base Surgery: A Prospective Cohort Study.." Asian journal of neurosurgery, 2026. PMID: 42535145 DOI: 10.1055/s-0046-1819645
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