{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T02:11:22Z","timestamp":1768529482442,"version":"3.49.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100017590","name":"Universit\u00e4tsklinikum Essen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100017590","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Studies have documented various effects of circadian rhythm and daytime variations on the cardiovascular and immune system as well as wound healing. From June to December 2016, <jats:italic>n<\/jats:italic>\u2009=\u2009367 cardiac surgery patients were enrolled. Microbiological swabs from the mediastinum and subcutaneous wound were taken before sternal closure. Patients were assigned to groups based on operation start: morning (<jats:italic>n<\/jats:italic>\u2009=\u2009219) or afternoon (<jats:italic>n<\/jats:italic>\u2009=\u2009135). Bacterial contamination and wound infections were studied in relation to circadian rhythm and daytime variation. We did not observe any difference in mortality (morning: 3.7%, afternoon: 3.0%, <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.99) and major adverse events (morning: 8.2%, afternoon: 5.9%, <jats:italic>p<\/jats:italic>\u2009=\u20090.53). In 27.7% of the morning group, at least one positive intraoperative swab was observed, similar to the afternoon group (25.6%, <jats:italic>p<\/jats:italic>\u2009=\u20090.71). The incidence of positive presternal swabs was 15.6% in the morning compared to 9.1% in the afternoon (<jats:italic>p<\/jats:italic>\u2009=\u20090.18). About 90% of the germs detected were part of the natural skin flora (e.g., Cutibacterium acnes and Staphylococcus epidermidis). The incidence of sternal wound infections was 7.3% (morning) and 3.0% (afternoon) (<jats:italic>p<\/jats:italic>\u2009=\u20090.18). We did not find differences in the incidence of intraoperative bacterial sternal contamination, nor postoperative infections, between patients who underwent cardiac surgery in the morning or afternoon.<\/jats:p>","DOI":"10.1038\/s41598-024-78435-x","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T18:02:25Z","timestamp":1730743345000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Circadian rhythm and daytime variation do not affect intraoperative bacterial sternal contamination and postoperative wound infections following cardiac surgery"],"prefix":"10.1038","volume":"14","author":[{"given":"Moritz Benjamin","family":"Immohr","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukiharu","family":"Sugimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Moza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payam","family":"Akhyari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Aljalloud","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"key":"78435_CR1","doi-asserted-by":"crossref","unstructured":"Mohd Azmi, N. A. S. et al. Cortisol on Circadian Rhythm and its Effect on Cardiovascular System. Int. J. Environ. Res. Public. Health ;18(2). (2021).","DOI":"10.3390\/ijerph18020676"},{"issue":"6","key":"78435_CR2","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1172\/JCI80590","volume":"128","author":"SS Thosar","year":"2018","unstructured":"Thosar, S. S., Butler, M. P. & Shea, S. A. Role of the circadian system in cardiovascular disease. J. Clin. Invest. 128 (6), 2157\u20132167 (2018).","journal-title":"J. Clin. Invest."},{"key":"78435_CR3","doi-asserted-by":"crossref","unstructured":"Zhang, J., Sun, R., Jiang, T., Yang, G. & Chen, L. Circadian blood pressure rhythm in Cardiovascular and Renal Health and Disease. Biomolecules ;11(6). (2021).","DOI":"10.3390\/biom11060868"},{"issue":"2","key":"78435_CR4","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.hrthm.2018.08.026","volume":"16","author":"N Black","year":"2019","unstructured":"Black, N. et al. Circadian rhythm of cardiac electrophysiology, arrhythmogenesis, and the underlying mechanisms. Heart Rhythm. 16 (2), 298\u2013307 (2019).","journal-title":"Heart Rhythm"},{"key":"78435_CR5","doi-asserted-by":"crossref","unstructured":"Zhang, L. & Jain, M. K. Circadian regulation of cardiac metabolism. J. Clin. Invest. ;131(15). (2021).","DOI":"10.1172\/JCI148276"},{"issue":"10115","key":"78435_CR6","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/S0140-6736(17)32132-3","volume":"391","author":"D Montaigne","year":"2018","unstructured":"Montaigne, D. et al. Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by rev-erbalpha antagonism: a single-centre propensity-matched cohort study and a randomised study. Lancet. 391 (10115), 59\u201369 (2018).","journal-title":"Lancet"},{"issue":"11","key":"78435_CR7","doi-asserted-by":"publisher","first-page":"3167","DOI":"10.1053\/j.jvca.2021.03.050","volume":"35","author":"M Michaud","year":"2021","unstructured":"Michaud, M., Beland, V., Noiseux, N., Forcillo, J. & Stevens, L. M. Daytime variation of clinical outcome in cardiac surgery: a propensity-matched cohort study. J. Cardiothorac. Vasc Anesth. 35 (11), 3167\u20133175 (2021).","journal-title":"J. Cardiothorac. Vasc Anesth."},{"issue":"1","key":"78435_CR8","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jtcvs.2019.11.131","volume":"162","author":"S Nemeth","year":"2021","unstructured":"Nemeth, S., Schnell, S., Argenziano, M., Ning, Y. & Kurlansky, P. Daytime variation does not impact outcome of cardiac surgery: results from a diverse, multi-institutional cardiac surgery network. J. Thorac. Cardiovasc. Surg. 162 (1), 56\u201367e44 (2021).","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"78435_CR9","doi-asserted-by":"publisher","first-page":"100140","DOI":"10.1016\/j.lanepe.2021.100140","volume":"7","author":"DP Fudulu","year":"2021","unstructured":"Fudulu, D. P. et al. Daytime and outcomes after cardiac surgery: systematic review and metaanalysis, insights from a large UK database review and post-hoc trial analysis. Lancet Reg. Health Eur. 7, 100140 (2021).","journal-title":"Lancet Reg. Health Eur."},{"issue":"4","key":"78435_CR10","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1097\/ALN.0000000000003728","volume":"134","author":"RM Hijazi","year":"2021","unstructured":"Hijazi, R. M. et al. Association between In-hospital mortality and low Cardiac output syndrome with morning versus afternoon cardiac surgery. Anesthesiology. 134 (4), 552\u2013561 (2021).","journal-title":"Anesthesiology"},{"issue":"5","key":"78435_CR11","doi-asserted-by":"publisher","first-page":"e14939","DOI":"10.1111\/ctr.14939","volume":"37","author":"MB Immohr","year":"2023","unstructured":"Immohr, M. B. et al. Impact of circadian rhythm and daytime variation on outcome after heart transplantation. Clin. Transpl. 37 (5), e14939 (2023).","journal-title":"Clin. Transpl."},{"issue":"3","key":"78435_CR12","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1038\/nri3386","volume":"13","author":"C Scheiermann","year":"2013","unstructured":"Scheiermann, C., Kunisaki, Y. & Frenette, P. S. Circadian control of the immune system. Nat. Rev. Immunol. 13 (3), 190\u2013198 (2013).","journal-title":"Nat. Rev. Immunol."},{"issue":"72","key":"78435_CR13","doi-asserted-by":"publisher","first-page":"eabm2465","DOI":"10.1126\/sciimmunol.abm2465","volume":"7","author":"C Wang","year":"2022","unstructured":"Wang, C., Lutes, L. K., Barnoud, C. & Scheiermann, C. The circadian immune system. Sci. Immunol. 7 (72), eabm2465 (2022).","journal-title":"Sci. Immunol."},{"issue":"11","key":"78435_CR14","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1164\/rccm.202202-0320OC","volume":"207","author":"M Felten","year":"2023","unstructured":"Felten, M. et al. Ventilator-induced Lung Injury is modulated by the circadian clock. Am. J. Respir Crit. Care Med. 207 (11), 1464\u20131474 (2023).","journal-title":"Am. J. Respir Crit. Care Med."},{"issue":"4","key":"78435_CR15","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1615\/CritRevImmunol.2015014925","volume":"35","author":"T Kizaki","year":"2015","unstructured":"Kizaki, T. et al. Effect of circadian rhythm on clinical and pathophysiological conditions and inflammation. Crit. Rev. Immunol. 35 (4), 261\u2013275 (2015).","journal-title":"Crit. Rev. Immunol."},{"issue":"8","key":"78435_CR16","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1042\/CS20220011","volume":"136","author":"S Fawcett","year":"2022","unstructured":"Fawcett, S. et al. A time to heal: microRNA and circadian dynamics in cutaneous wound repair. Clin. Sci. (Lond). 136 (8), 579\u2013597 (2022).","journal-title":"Clin. Sci. (Lond)"},{"key":"78435_CR17","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.physbeh.2016.12.019","volume":"171","author":"EJ Cable","year":"2017","unstructured":"Cable, E. J., Onishi, K. G. & Prendergast, B. J. Circadian rhythms accelerate wound healing in female siberian hamsters. Physiol. Behav. 171, 165\u2013174 (2017).","journal-title":"Physiol. Behav."},{"issue":"11","key":"78435_CR18","first-page":"317","volume":"26","author":"M Sipahi","year":"2014","unstructured":"Sipahi, M., Zengin, K., Tanik, S., Arslan, E. & Cubukcu, A. Effects of circadian rhythm disorders on wound healing and strength of bowel anastomosis in rats. Wounds. 26 (11), 317\u2013322 (2014).","journal-title":"Wounds"},{"issue":"1","key":"78435_CR19","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.athoracsur.2022.04.054","volume":"115","author":"R Perezgrovas-Olaria","year":"2023","unstructured":"Perezgrovas-Olaria, R. et al. Deep Sternal Wound infection and mortality in cardiac surgery: a Meta-analysis. Ann. Thorac. Surg. 115 (1), 272\u2013280 (2023).","journal-title":"Ann. Thorac. Surg."},{"issue":"2","key":"78435_CR20","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ejcts\/ezab080","volume":"60","author":"AE Kaspersen","year":"2021","unstructured":"Kaspersen, A. E. et al. Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART. Eur. J. Cardiothorac. Surg. 60 (2), 233\u2013241 (2021).","journal-title":"Eur. J. Cardiothorac. Surg."},{"issue":"8","key":"78435_CR21","doi-asserted-by":"publisher","first-page":"E482","DOI":"10.1097\/BRS.0b013e3182893be1","volume":"38","author":"SV Nandyala","year":"2013","unstructured":"Nandyala, S. V. & Schwend, R. M. Prevalence of intraoperative tissue bacterial contamination in posterior pediatric spinal deformity surgery. Spine (Phila Pa. 1976). 38 (8), E482\u2013E486 (2013).","journal-title":"Spine (Phila Pa. 1976)"},{"issue":"20","key":"78435_CR22","doi-asserted-by":"publisher","first-page":"1722","DOI":"10.2106\/JBJS.15.01133","volume":"98","author":"TM Falconer","year":"2016","unstructured":"Falconer, T. M. et al. Contamination of the Surgical Field with Propionibacterium acnes in primary shoulder arthroplasty. J. Bone Joint Surg. Am. 98 (20), 1722\u20131728 (2016).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"spe1","key":"78435_CR23","doi-asserted-by":"publisher","first-page":"e243232","DOI":"10.1590\/1413-785220223001e243232","volume":"30","author":"AZ Alomar","year":"2022","unstructured":"Alomar, A. Z., Alfayez, S. M., Binnasser, A. & Aljassir, F. F. Intraoperative Evaluation and Level of Contamination during total knee arthroplasty. Acta Ortop. Bras. 30 (spe1), e243232 (2022).","journal-title":"Acta Ortop. Bras."},{"issue":"2","key":"78435_CR24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3109\/17453674.2014.899848","volume":"85","author":"EO Jonsson","year":"2014","unstructured":"Jonsson, E. O., Johannesdottir, H., Robertsson, O. & Mogensen, B. Bacterial contamination of the wound during primary total hip and knee replacement. Median 13 years of follow-up of 90 replacements. Acta Orthop. 85 (2), 159\u2013164 (2014).","journal-title":"Acta Orthop."},{"issue":"11","key":"78435_CR25","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1007\/s10096-014-2168-x","volume":"33","author":"K Falk-Brynhildsen","year":"2014","unstructured":"Falk-Brynhildsen, K., Soderquist, B., Friberg, O. & Nilsson, U. Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial skin sealant. Eur. J. Clin. Microbiol. Infect. Dis. 33 (11), 1981\u20131987 (2014).","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"78435_CR26","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.jhin.2023.03.018","volume":"135","author":"N Sandstrom","year":"2023","unstructured":"Sandstrom, N., Soderquist, B., Wistrand, C. & Friberg, O. The presence of skin bacteria in the sternal wound and contamination of implantation materials during cardiac surgery. J. Hosp. Infect. 135, 145\u2013151 (2023).","journal-title":"J. Hosp. Infect."},{"issue":"3","key":"78435_CR27","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1055\/s-0042-1742422","volume":"14","author":"JA Santoshi","year":"2022","unstructured":"Santoshi, J. A. et al. Intraoperative Surgical Wound Contamination May not lead to Surgical-Site infection in patients undergoing clean orthopaedic procedures. J. Lab. Physicians. 14 (3), 284\u2013289 (2022).","journal-title":"J. Lab. Physicians"},{"issue":"5","key":"78435_CR28","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1016\/j.surg.2023.05.031","volume":"174","author":"M Kowalewski","year":"2023","unstructured":"Kowalewski, M. et al. Topical Vancomycin for sternal wound infection prophylaxis. A systematic review and updated meta-analysis of over 40,000 cardiac surgery patients. Surgery. 174 (5), 1102\u20131112 (2023).","journal-title":"Surgery"},{"issue":"4","key":"78435_CR29","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1053\/j.jvca.2009.02.007","volume":"23","author":"F Filsoufi","year":"2009","unstructured":"Filsoufi, F. et al. Epidemiology of deep sternal wound infection in cardiac surgery. J. Cardiothorac. Vasc Anesth. 23 (4), 488\u2013494 (2009).","journal-title":"J. Cardiothorac. Vasc Anesth."},{"issue":"5\u20136","key":"78435_CR30","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1080\/14017431.2016.1180427","volume":"50","author":"T Gudbjartsson","year":"2016","unstructured":"Gudbjartsson, T. et al. Sternal wound infections following open heart surgery - a review. Scand. Cardiovasc. J. 50 (5\u20136), 341\u2013348 (2016).","journal-title":"Scand. Cardiovasc. J."},{"key":"78435_CR31","doi-asserted-by":"publisher","first-page":"1379410","DOI":"10.3389\/fsurg.2024.1379410","volume":"11","author":"GI Verras","year":"2024","unstructured":"Verras, G. I. & Mulita, F. Butyrylcholinesterase levels correlate with surgical site infection risk and severity after colorectal surgery: a prospective single-center study. Front. Surg. 11, 1379410 (2024).","journal-title":"Front. Surg."},{"key":"78435_CR32","doi-asserted-by":"publisher","first-page":"910222","DOI":"10.3389\/fsurg.2022.910222","volume":"9","author":"X Wu","year":"2022","unstructured":"Wu, X., Ma, X., Zhu, J. & Chen, C. C-reactive protein to lymphocyte ratio as a new biomarker in predicting surgical site infection after posterior lumbar interbody fusion and instrumentation. Front. Surg. 9, 910222 (2022).","journal-title":"Front. Surg."},{"issue":"9","key":"78435_CR33","doi-asserted-by":"publisher","first-page":"e25007","DOI":"10.1097\/MD.0000000000025007","volume":"100","author":"Y Zhuo","year":"2021","unstructured":"Zhuo, Y., Cai, D., Chen, J., Zhang, Q. & Li, X. Pre-surgical peripheral blood inflammation markers predict surgical site infection following mesh repair of groin hernia. Med. (Baltim). 100 (9), e25007 (2021).","journal-title":"Med. (Baltim)."},{"issue":"2","key":"78435_CR34","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.surge.2018.05.006","volume":"17","author":"Y Aljabi","year":"2019","unstructured":"Aljabi, Y., Manca, A., Ryan, J. & Elshawarby, A. Value of procalcitonin as a marker of surgical site infection following spinal surgery. Surgeon. 17 (2), 97\u2013101 (2019).","journal-title":"Surgeon"},{"issue":"2","key":"78435_CR35","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1055\/s-0034-1394188","volume":"76","author":"Z Tempel","year":"2015","unstructured":"Tempel, Z. et al. Prealbumin as a serum biomarker of impaired perioperative nutritional status and risk for surgical site infection after spine surgery. J. Neurol. Surg. Cent. Eur. Neurosurg. 76 (2), 139\u2013143 (2015).","journal-title":"J. Neurol. Surg. Cent. Eur. Neurosurg."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78435-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78435-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78435-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T21:19:48Z","timestamp":1731014388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-024-78435-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["78435"],"URL":"https:\/\/doi.org\/10.1038\/s41598-024-78435-x","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,4]]},"assertion":[{"value":"22 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The ethical approval of the study was granted by the local ethics committee (local trial approval and registration number: EK 151\/09 version 1.2.3, March 2016). The study followed the principles of the Declaration of Helsinki, and all patients gave their written informed consent for the scientific use of anonymized patient data before inclusion.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"26695"}}