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PATIENT SPECIFIC FACTORS OF STERILE INFLAMMATION MARKERS OF CONVALESCENCE FOLLOWING LAPAROSCOPIC SURGERY-RESULTS OF A TRIPLE BLIND RANDOMIZED CONTROL STUDY

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

Patient/Operative Variant n=100; Mean (range)
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
PAIKn markers & Liver-Pancreas biochemistry [Mean (range)]
  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

58

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