Laparoscopic Surgery Can Reduce Postoperative Edema Compared with Open Surgery

Risk Factors and Patient Outcomes Associated With Immediate Post-operative Anasarca Following Major Abdominal Surgeries: A Prospective Observational Study From 2019 to 2021

Introduction: Anasarca is well-known and refers to generalized edema caused by underlying clinical conditions and unknown risk factors in the patient. However, it is a relatively unexplored postoperative symptom following major abdominal surgeries. It is associated with poor patient outcomes in terms of delayed recovery and associated severe complications. Pedal edema is an early sign of post-operative anasarca, which progresses into an unfavorable clinical condition due to generalized edema followed by multiple organ dysfunction. 

Aim: This study aimed to assess risk factors and complications associated with postoperative anasarca among patients undergoing major abdominal surgery.

Methods and material: The prospective observational study included 241 patients undergoing major abdominal surgeries from July 2019 to February 2021 in a tertiary care health centre in Rajasthan, India. Risk factors like age, nutritional parameters, addictions like smoking, alcohol intake, opium intake, leukocytosis, and Charlson Comorbidity Index were assessed. Postoperative complications were graded by the Clavien-Dindo grading system. Mean, standard deviation, percentages, Pearson’s Chi-square test and Student’s t-test were used to analyze the data. 

Results: The incidence of anasarca was found to be 29.87%. Nutritional risk screening (NRS) 2002 score, albumin, age > 60 years and raised leukocyte counts were found to significantly correlate (p-value <0.05) with the development of anasarca postoperatively. Postoperative complications, according to Clavien-Dindo grading, were 16.67% in grade I (p value=0.002), 13.89% in grade II (p-value =0.199), 1.39% in grade III (p value=0.049), 20.83% in grade IV (p value<0.001), and 41.67% in grade V (p value<0.001).

Conclusion: Higher NRS 2002 score, low albumin levels, age > 60 years and raised leukocyte counts are significantly correlated with the development of postoperative anasarca. Postoperative anasarca is found to be a significant predictor of poor prognosis of patients undergoing major abdominal surgery. 

Application of an early oral feeding protocol after pylorus-preserving pancreaticoduodenectomy

PURPOSE

This study evaluates the effect of an enhanced recovery after surgery (ERAS)-based nutrition support protocol on oral intake and weight change in patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD).

METHODS

A 14-day postoperative nutrition support protocol was developed to initiate oral intake after 1 week of enteral tube feeding and parenteral nutrition (early oral feeding, EOF). Forty-eight patients who underwent PPPD participated in the study (non-EOF, n = 23; EOF, n = 25). General information, nutrition supply route and amount, blood chemistry, and weight changes were tracked.

RESULTS

The enteral tube feeding duration was 2.7 days shorter in the EOF group than in the non-EOF group. Furthermore, the EOF group started oral liquid and soft diets 1.1 and 2.5 days earlier than the non-EOF group, respectively. Compared with the non-EOF group, the EOF group reported a higher energy intake (22.1%; p = 0.001) and protein intake (17.4%; p = 0.000) via oral route. Although cumulative energy and protein intakes were similar in both groups, weight reduction in the EOF group (3.6 ± 0.1%, 2.2 ± 0.7 kg) was significantly less than the non-EOF group (8.2 ± 0.9%, 5.2 ± 0.5 kg). The blood levels of total protein and transferrin increased and prealbumin decreased, regardless of the EOF application. Serum albumin increased significantly only in the EOF group.

CONCLUSION

The EOF protocol developed for post-PPPD patients enables the early initiation and increase in the amount of oral intake while significantly alleviating weight loss.