Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery

Helander, Erik; Webb, Michael P.; Menard, Bethany L.; Prabhakar, Amit; Helmstetter, John A.; Cornett, Elyse M.; Urman, Richard D.; Nguyen, Viet; Kaye, Alan D.

doi:10.1007/s11916-019-0770-4

Cited by 52 publications

(44 citation statements)

References 69 publications

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“…Indirect surgical trauma occurs through events such as blood loss, alterations in blood pressure, and perfusion. Direct surgical injury is the result of incisions through different layers of the abdominal wall, the mobilisation of organs, and resection of organs or tissue [36]. The response starts with the release of cytokine and inflammatory mediators that control a complex process of metabolic, hormonal, and immunological processes, which subsequently results in the breakdown of muscle protein [37].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for surgery-related muscle quantity and muscle quality loss and their impact on outcome

et al. 2021

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Background Surgery-related loss of muscle quantity negatively affects postoperative outcomes. However, changes of muscle quality have not been fully investigated. A perioperative intervention targeting identified risk factors could improve postoperative outcome. This study investigated risk factors for surgery-related loss of muscle quantity and quality and outcomes after liver resection for colorectal liver metastasis (CRLM). Methods Data of patients diagnosed with CRLM who underwent liver resection between 2006 and 2016 were analysed. Muscle quantity (psoas muscle index [PMI]), and muscle quality, (average muscle radiation attenuation [AMA] of the psoas), were measured using computed tomography. Changes in PMI and AMA of psoas after surgery were assessed. Results A total of 128 patients were analysed; 67 (52%) had surgery-related loss of muscle quantity and 83 (65%) muscle quality loss. Chronic obstructive pulmonary disease (COPD) (P = 0.045) and diabetes (P = 0.003) were risk factors for surgery-related loss of muscle quantity. A higher age (P = 0.002), open resection (P = 0.003) and longer operation time (P = 0.033) were associated with muscle quality loss. Overall survival was lower in patients with both muscle quantity and quality loss compared to other categories (P = 0.049). The rate of postoperative complications was significantly higher in the group with surgery-related loss of muscle quality. Conclusions Risk factors for surgery-related muscle loss were identified. Overall survival was lowest in patients with both muscle quantity and quality loss. Complication rate was higher in patients with surgery-related loss of muscle quality.

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Section: Discussionmentioning

confidence: 99%

Risk factors for surgery-related muscle quantity and muscle quality loss and their impact on outcome

et al. 2021

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“…The postoperative concentration of IL-6 is most consistently increased compared to those of other cytokines (Unver & McAllister, 2018). It was reported that CRP and IL-6 levels were positively correlated with the magnitude of the stress response in major surgeries, and laparoscopic surgeries are associated with lower levels of CRP and IL-6 than the corresponding open procedures (Helander et al, 2019;Watt et al, 2015). In contrast, IL-10 functions as an anti-inflammatory interleukin and the levels gradually increase in the early stages of premalignant oral tumors (Sun et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Hormonal dysregulation resulting from these processes can impede recovery and increase morbidity (Helander et al, 2019). Cortisol is an essential regulator for maintaining normal homeostasis and a useful indicator of short-term stress (Calcaterra et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Comparison of postoperative cytokine and hormone between endoscopically assisted and open parotid tumor resection

Zhao

Jiao

et al. 2020

Oral Diseases

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The majority of parotid gland neoplasms are benign tumors and are conventionally resected by open parotidectomy through an S-shaped preauricular and submandibular incision. The pitfalls associated with this open procedure include a relatively large surgical impact, the risk of facial paralysis, intraoperative bleeding, a long operation time, and a large and aesthetically unpleasant scar (Yan & Chen, 2015). Many studies have shown that open surgery physiologically perturbs the inner environment, causes a chain of

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“…First, as an important predictor for length of hospital stay, time to return of gastrointestinal function did not differ between groups. Second, alleviating stress and promoting early recovery require multi-disciplinary and multi-module management interventions (Helander, et al, 2019), whereas preoperative carbohydrate loading is only a part of the Enhanced Recovery After Surgery (ERAS) bundles (Gustafsson, et al, 2019;Mortensen, et al, 2014). It is di cult to demonstrate the absolute bene t from a single intervention due to its limited value.…”

Section: Discussionmentioning

confidence: 99%

Preoperative carbohydrate loading in diabetic patients undergoing gastrointestinal surgery: A pilot randomized trial

Xue

Lin

Liang

et al. 2020

Preprint

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BackgroundPreoperative carbohydrate loading is used to improve patients’ comfort and recovery, but evidence remains limited in diabetic patients. We tested the feasibility of a preoperative carbohydrate drink with supplemental insulin in diabetic patients for gastrointestinal surgery.MethodsAdult patients with type 2 diabetes mellitus who were scheduled for major gastrointestinal surgery were randomized to carbohydrate group (carbohydrate drink with supplement insulin selectively) or control group (clinical routine management). The primary outcome was the time to first flatus after surgery. Among secondary outcomes, subjective feelings of thirsty, hunger and fatigue were assessed with the Visual Analogue Scale (scores range from 0 to 100, where 0 indicate no discomfort and 100 the most severe discomfort) before and after surgery.ResultsA total of 63 patients were randomized. Time to first flatus did not differ between groups (median [95% CI], 40 hours [30, 50] in control group vs. 43 hours [37, 48] in carbohydrate group, hazard ratio [95% CI], 1.24 [0.74, 2.07], P = 0.411). Both pre- and postoperative subjective feelings of discomfort were all significantly lower in carbohydrate group than in control group (median difference from − 50 to 0; all P < 0.05). Patients with carbohydrate drink developed less intraoperative hypotension (40.6% [13/30] vs. 16.1% [5/31], P = 0.031) and postoperative nausea and vomiting within 24 hours (31.3% [10/32] vs. 9.7% [3/31], P = 0.034).ConclusionIn diabetic patients undergoing gastrointestinal surgery, preoperative carbohydrate loading with supplemental insulin selectively did not affect gastrointestinal recovery; but it improved perioperative comfort, and reduced intraoperative hypotension and postoperative nausea and vomiting.Trial RegistrationClinicalTrial.gov, NCT03204344; Registered July 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03204344.

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Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery

Cited by 52 publications

References 69 publications

Risk factors for surgery-related muscle quantity and muscle quality loss and their impact on outcome

Risk factors for surgery-related muscle quantity and muscle quality loss and their impact on outcome

Comparison of postoperative cytokine and hormone between endoscopically assisted and open parotid tumor resection

Preoperative carbohydrate loading in diabetic patients undergoing gastrointestinal surgery: A pilot randomized trial

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