Development of postoperative insulin resistance is associated with the magnitude of operation.
OBJECTIVE
To study the development of insulin resistance and changes in stress hormone concentrations in patients undergoing elective operations of different magnitude.


METHODS
Prospective open study.


METHODS
University hospital, Sweden.


METHODS
12 otherwise healthy patients, undergoing elective surgery for cholecystectomy (n = 6) and inguinal hernia repair (n = 6).


METHODS
Insulin sensitivity was measured by the normoglycaemic, hyperinsulinaemic glucose clamp technique before operation (control) and on the first postoperative day.


METHODS
Relative insulin sensitivity (compared with preoperative) on the day after each operation. Changes in stress hormone concentrations in relation to the relative change in insulin sensitivity.


RESULTS
After hernia repair, mean (SEM) insulin sensitivity was reduced by 32 (4)%, p < 0.05 compared with baseline, and after open cholecystectomy by 56 (3)%, (p < 0.05). The difference between the two groups was highly significant (p < 0.01). The changes in concentrations of catecholamines, glucagon, cortisol and growth hormone after operation were only small, and did not correlate with the relative changes in insulin sensitivity.


CONCLUSIONS
Insulin resistance develops even after a minor elective operation, (inguinal hernia repair). The degree of postoperative insulin resistance was more pronounced after open cholecystectomy. The alteration in insulin sensitivity could not be related to simultaneous changes in the hormones studied.
Thorell
A
A
Department of Surgery, Karolinska Hospital & Institute, Stockholm, Sweden.
Efendic
S
S
Gutniak
M
M
Häggmark
T
T
Ljungqvist
O
O
D002395:Catecholamines / Q000097:blood; D002763:Cholecystectomy; D005260:Female; D005934:Glucagon / Q000097:blood; D005951:Glucose Tolerance Test; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013312:Stress, Physiological / Q000378:metabolism / Q000503:physiopathology*
D002395:Catecholamines; D005934:Glucagon; D006854:Hydrocortisone