Risk factors for hypokalemia and its association with postoperative recovery in patients scheduled for radical gastrectomy: a retrospective study

Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients: A Propensity Score Matching Study

OBJECTIVE

This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.

METHODS

This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022. Data were collected for each patient, including demographics, disease status, surgical data, and clinical information. Preoperative bowel preparation, postoperative gastrointestinal function, and electrolyte levels were compared between the two groups using propensity score matching (PSM).

RESULTS

The incidence of hypokalemia (serum potassium level <3.5 mmol/L) during the recovery period from anesthesia was approximately 43.75%. After PSM, oral laxative use (96.4% vs. 82.4%, P=0.005), the number of general enemas (P=0.014), and the rate of ≥2 general enemas (92.9% vs. 77.8%, P=0.004) were identified as risk factors for hypokalemia, which was accompanied by decreased PaCO2 and hypocalcemia. There were no significant differences in postoperative gastrointestinal outcomes, such as the time to first flatus or feces, the I-FEED score (a scoring system was created to evaluate impaired postoperative gastrointestinal function), or postoperative recovery outcomes, between the hypokalemia group and the normal serum potassium group.

CONCLUSION

Hypokalemia during postanesthesia recovery period occurred in 43.75% of gynecological patients, which resulted from preoperative mechanical bowel preparation; however, it did not directly affect clinical outcomes, including postoperative gastrointestinal function, postoperative complications, and length of hospital stay.

A Comparative Study Between the Early and Late Enteral Nutrition After Gastrointestinal Anastomosis Operations

INTRODUCTION

Intestinal anastomosis is a surgical procedure crucial for restoring the integrity of the digestive system and finds widespread application in addressing diverse gastrointestinal disorders such as tumors, inflammatory conditions, and traumatic injuries. The timing of restarting feeding after the surgery is a debated topic due to its potential impact on patient recovery. Early enteral feeding, administered soon after surgery, aims to counteract the negative effects of prolonged fasting and improve outcomes.

OBJECTIVE

This study analyzed the early and late enteral feeding following gastrointestinal anastomosis surgery.

METHODS

Forty patients undergoing abdominal surgery were prospectively randomized into early or late feeding groups. Demographics, laboratory values, operative time, blood loss, transfusion rates, nasogastric tube (NGT) removal, hospital stay, gastrointestinal recovery, postoperative body mass index (BMI), and complications were compared. Data was organized in Excel and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY). Qualitative data were presented with numbers and percentages, while parametric quantitative data used means, standard deviations, and ranges. Non-parametric quantitative data were represented with medians and interquartile ranges. Chi-square tests were used for comparing two qualitative groups with predicted counts less than 5, while independent t-tests and Mann-Whitney tests were employed for comparing two quantitative groups with parametric and non-parametric distributions, respectively. The analysis used a 95% confidence interval, a 5% margin of error, and considered P values less than 0.05 as significant.

RESULTS

Early feeding was associated with significantly shorter NGT removal times (p=0.005) and hospital stays (p=0.001) than late feeding. Postprandial potassium levels were higher in the early group (p=0.007), while CRP levels were significantly lower (p=0.004). No significant differences were found in operative time, blood loss, transfusion rates, gastrointestinal recovery, postoperative BMI, or complication rates between groups.

CONCLUSIONS

Early enteral feeding appears safe and effective after gastrointestinal anastomosis surgery, potentially reducing hospital stay and improving inflammatory markers without increasing adverse events.