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When macrophages are recruited by adipose tissue due to the overexpression of monocyte chemoattractant protein 1 (MCP1, a chemokine ligand also known as CCL2), hepatic insulin resistance is observed with increased TNF expression in adipose tissue, but without any change in body weight or adiposity [148]

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Despite improvements in surgical techniques and perioperative care, the development of perioperative organ dysfunction such as acute heart failure, stroke, acute kidney injury (AKI), or liver injury remains directly associated with worse outcomes and significant mortality ( It is now recognized that excessive inflammation plays a pivotal role in perioperative organ damage (7)

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