Influence of Subclinical Chronic Inflammation on the Systemic Inflammatory Response After Surgical Procedures

Abstract

Subclinical chronic inflammation has emerged as a prevalent condition among individuals with metabolic, cardiovascular, and inflammatory diseases, potentially influencing the biological response to surgical trauma. Recent evidence suggests that this baseline inflammatory state acts as a modulator of the systemic inflammatory response in the perioperative period, amplifying pro-inflammatory cytokine release and increasing the risk of postoperative complications. The objective of this study was to analyze, through a narrative literature review, the role of subclinical chronic inflammation as an amplifier of the postoperative inflammatory response, in light of the “second hit” theory. A search was conducted in international databases, including clinical and experimental studies addressing baseline inflammatory markers, surgical response, and postoperative outcomes. Findings indicate that elevated preoperative levels of C-reactive protein, neutrophil-to-lymphocyte ratio, and other inflammatory cytokines are associated with greater intensity of systemic inflammatory response following surgery. Patients with obesity, metabolic syndrome, and multimorbidity demonstrate enhanced cytokine release, prolonged inflammatory activity, and higher rates of infectious complications and extended hospital stay. Mechanistically, persistent activation of innate immunity, immunometabolic dysfunction, and endothelial impairment appear to play central roles in this process. In conclusion, subclinical chronic inflammation functions as a relevant modulatory factor in perioperative risk, representing a potential biological “second hit” that amplifies the response to surgical trauma.