Operative Procedures, Complications Clinical Trial
Official title:
Predictive Value of Surgical Stress Markers for Postoperative Complications: a Prospective Study
The aim of this study is to evaluate the predictive value of albumine, C-reactive protein (CRP), procalcitonin, and lactates in terms of surgical stress and postoperative complications. These biomarkers will be measured from the day before surgery until postoperative day four in patients undergoing major surgery. Major surgery was defined as esophagus, gastric, liver, pancreas, endocrine, retroperitoneal, or colorectal procedures including an organ resection for benign or malignant disease and lasting more than 2 hours.
This prospective study was conducted at the Department for Visceral Surgery at the University
Hospital of Lausanne Switzerland (CHUV) between February and December 2015 (NCT02356484). The
study was approved by the Institutional Review Board (No. 367/15), and all patients provided
written consent prior to surgery. Inclusion criteria were age >18 years, and elective major
abdominal surgery—defined as an operative procedure with anticipated duration ≥2 hours.17
Perioperative care closely adhered to recently published enhanced recovery guidelines
(http://erassociety.org.loopiadns.com/guidelines/list-of-guidelines). Standardised fluid
administration was followed by advanced haemodynamic monitoring to avoid intraoperative fluid
overload. According to the clinical care pathway, intravenous fluid was typically
discontinued the morning after surgery.
Biological markers Serum levels of albumin, CRP, PCT and lactate (LCT) were perioperatively
measured in a fasting state, Following standardised institutional guidelines. Blood samples
were drawn the day before surgery, the day of surgery (4-6 hours after the end of the
operation) and on the first, second and third postoperative day. As Baseline values tend to
show large variations especially for albumin,4 10 we considered that a dynamic value
(difference between two time-points) might be more informative than a snapshot value. Several
values based on preoperative and postoperative concentrations were thus calculated for each
marker (ie, Δ Max: maximal difference between the preoperative and postoperative values; Δ
POD 0: difference of concentration on POD −1 and POD 0; Δ POD 1: difference of concentration
on POD−1 and POD 1).
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