Nayan Agarwal, Juhil D Nanavati, DNB, Neeraj Dhamija, DNB, Brij B Agarwal, MS, Satish Saluja, MD. Sir Ganga Ram Hospital & GRIPMER, India
INTRODUCTION: Enhanced recovery after surgery (ERAS) in post-operative convalescence (POC) following minimally invasive surgery (MIS) is determined by sterile inflammation which is mediated by an interplay between pro/anti-inflammatory and immunosuppressive cytokine cascades (PAIKn). The PAIKn & POC vary, even in similar surgeries. Damage associated molecular patterns (DAMPs) trigger PAIKn, driven dominantly by interleukine-6 (IL6). Heat shock protein (HSP), the thermal equivalent of DAMP, has distinct IL6- PAIKn footprint. We studied the patient-specific markers for subjective POC & PAIKn association, in ERAS compatible clinical-pathway for index MIS i.e.cholecystectomy.
METHODS AND PROCEDURES: (RCT-Clinical trials registry, India. REF/2014/06/007153). Randomization to energy use or non-use was done for HSP being the dominant/ potential confounder. Patient demographics perioperative data, PAIKn markers & hepatopancreatic data [ juxta-operative(H0),at 4-hours(H4)&at 24-hours(H24)], were prospectively collated.
Results
| Age- years | 44.18(18-76) |
| Gender | M = 29, F = 71 |
| Kuppuswamy Socio-Economic Class | Upper = 20, Upper-middle = 32, Lower-middle = 36, Upper-lower = 11, Lower = 1 |
| BMI(kg/m2) | 22.9 (16.45-32.04) |
| Acute/Chronic | Acute=11,Chronic=89 |
| Comorbidities | DM=14,HTN=11,Others=17 |
| Substance abuse | Alcohol=24, Smokers=14 |
| ASA Grade | I=65,II=34,III=1,IV=0,V=0 |
| GB perforation | Occured in 26 patients |
| Operative time(min.) | 31.8(12-98) |
| Discharge fitnes(hrs) | 5.9(3-28) |
| Return to normal act | 4.95(2-36)days |
| H0 | H 4 | H24 | |
|---|---|---|---|
| IL-6 | 6.808 (0.22-135.8) | 24.9549 (2-485.48) | 28.0373 (1.39-442) |
| HS-CRP | 0.8985 (0.02-21.37) | 1.30885 (0.02-21.77) | 3.6922 (0.05-24.6) |
| TNF α | 9.4306 (0.02-38.6) | 12.8645(0.02-39.1) | 14.3929(0.71-61.9) |
| SGOT | 29.03(7-200) | 48.86(17-428) | 39.08(18-116) |
| SGPT | 33.39(7-184) | 42.9(11-198) | 40.17(14-154) |
| ALP | 82.2454(14-314) | 78.2(26-249) | 76.71(21-241) |
| GGT | 28.1922(4-289) | 28.59(5-245) | 27.39(7-185) |
| Amylase | 64.4692(18-496) | 57.35(15-291) | 61.32(14-240) |
| Lipase | 34.28(9-79) | 30.46(9-66) | 33.69(8-69) |
Data(following standard scales/metrics)for Patient-Reported-Outcomes e.g. pain, nausea-vomiting, & fatigue will be analyzed with the above data and the analysis with conclusions will be presented & discussed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87843
Program Number: P357
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster