Effects of Stress Response on Wound Healing

The cumulative physiologic effects of psychological, physical and surgical stress result in hypothalamic-pituitary-adrenal (HPA) mediated peripheral vasoconstriction and elevated serum cortisol levels, both of which have been implicated in wound healing. The purpose of this study was to describe the affects of both preoperative and postoperative psychological stress and minor and moderate surgical stress on wound healing in the hope of gaining insight into what characteristics within individuals are most likely to equate with efficient would healing.

Methods. Seventy-seven subjects (mean age 47 +/- 20) undergoing either knee arthroscopy or arthroplasty completed the protocol. Subjects completed preoperative and postoperative questionnaires to capture the psychological and physiological impact of each individual's stress level as well as coping strategies used. Preoperative and postoperative urine samples (days 0-7) were analyzed for urine catecholamines and cortisol. Wound healing (histology, hydroxyproline, pro alpha 1[I] collagen mRNA) was evaluated in tissue obtained via a subcutaneous polytetrafluoroethylene (ePTFE) implants removed on the 7^th postoperative day and by direct evaluation of surgical wounds using the ASEPSIS system.

Results. Preoperative anxiety was negatively associated with surgical wound outcome (total score, drainage and redness). Specific coping behaviors were associated with positive histologic and biochemical measures of healing, including increased hydroxyproline and cellularity. In addition, there was a significant relationship between higher levels of norepinephrine in the first 7 postoperative days, and poorer healing score in the surgical wound.

Conclusions. These data suggest that the ways in which individuals prepare for and cope with the stress of pending surgery, as well as post surgical HPA mediated stress have consequences for wound healing.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2003102...