Clinical Study of Perioperative Nutritional Status and Post-operative Fluid Management Related Complications in Gastrointestinal Surgeries at a Tertiary Hospital in Thiruvananthapuram
Introduction: Gastrointestinal surgery patients are at risk of nutritional depletion from inadequate nutritional intake, surgical stress, and dehydration. Reasonable selection of proportion and infusion order of crystalloid and colloid is necessary in fluid and nutrition support. In this study, we evaluated perioperative nutritional status of patients and post-operative fluid management related complications in gastrointestinal surgery.
Aims of the Study: (1) To assess the perioperative nutritional status of the patients undergoing gastrointestinal surgery, (2) to correlate nutritional status and the incidence of fluid management related complications postoperatively, (3) post-operative fluid management, the role of colloids and crystalloids.
Materials and Methods: Source of data: This study was a prospective analysis conducted on 51 patients who underwent gastrointestinal and biliary surgery in the Department of Surgery, Medical College, Thiruvananthapuram, during the period 2003-2004.
Results: In emergency surgeries, of 29 bowel perforation surgeries, 13 patients postoperatively developed pulmonary edema and hypotension. In elective surgeries, most of the cases were malignancies with chronic starvation, weight loss, and dehydration showed low blood parameters and had a higher incidence of complications. In long duration surgeries, patients having duration of surgery >4 h had more complications compared to a shorter duration. 7 of 8 carcinoma stomach and all pancreas carcinoma patients developed post-operative complications. Malnourishment and low albumin levels affected the post-operative outcome. Mortality rate in emergency cases (12) was more than the elective ones (7).
Conclusions: Complications were more in emergency and long duration surgeries than in elective and short duration surgeries. Malnourishment and low albumin levels affected the post-operative outcome. Pre-operative nutritional assessment is highly valuable in determining the type and amount of fluid to be administered for a particular patient to prevent complications. Reducing duration of surgery and correction of blood parameters with titrated fluids can reduce the post-operative complications.
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