A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.

Details

Ressource 1Download: Mantziari2015_Article_ANovelApproachToMajorSurgeryTr.pdf (1539.60 [Ko])
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_E108160E7B34
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.
Journal
World Journal of Surgery
Author(s)
Mantziari S., Hübner M., Coti-Bertrand P., Pralong F., Demartines N., Schäfer M.
ISSN
1432-2323 (Electronic)
ISSN-L
0364-2313
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
39
Number
11
Pages
2641-2651
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
BACKGROUND: To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications.
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.
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.
CONCLUSIONS: Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes.
Keywords
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
Pubmed
Web of science
Open Access
Yes
Create date
03/11/2015 17:25
Last modification date
10/02/2022 7:12
Usage data