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A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.
- Source :
-
World journal of surgery [World J Surg] 2015 Nov; Vol. 39 (11), pp. 2641-51. - Publication Year :
- 2015
-
Abstract
- Background: To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications.<br />Methods: We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5 days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p < 0.05 was the significance threshold.<br />Results: Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240 min operative (OR) time and 300 ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of 'major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels.<br />Conclusions: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes.
- Subjects :
- Adult
Aged
Aged, 80 and over
Biomarkers blood
C-Reactive Protein analysis
Cholecystectomy, Laparoscopic methods
Female
Humans
Laparoscopy methods
Male
Middle Aged
Pancreatectomy methods
Pilot Projects
Postoperative Complications etiology
Prospective Studies
Surgical Procedures, Operative methods
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2323
- Volume :
- 39
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- World journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26243563
- Full Text :
- https://doi.org/10.1007/s00268-015-3181-7