title: Oedema is associated with clinical outcome following emergency abdominal surgery.
abstract: BACKGROUND
  Oedema is observed frequently following surgery and may be associated with worse outcomes. To date, no study has investigated the role of oedema in the emergency surgical patient. This study assesses the incidence of oedema following emergency abdominal surgery and the value of early postoperative oedema measurement in predicting clinical outcome.
  
  
  METHODS
  A prospective cohort study of patients undergoing emergency abdominal surgery at a university unit over a two-month period was undertaken. Nutritional and clinical outcome data were collected and oedema was measured in the early postoperative period. Predictors of oedema and outcomes associated with postoperative oedema were identified through univariate and multivariate analysis.
  
  
  RESULTS
  Overall, 55 patients (median age: 66 years) were included in the study. Postoperative morbidity included ileus (n=22) and sepsis (n=6) with 12 deaths at follow-up. Postoperative oedema was present in 19 patients and was associated with prolonged perioperative fasting (107 vs 30 hours, p=0.009) but not with body mass index (24 kg/m(2) vs 27 kg/m(2), p=0.169) or preadmission weight loss (5% vs 3%, p=0.923). On multivariate analysis, oedema was independently associated with gastrointestinal recovery (B=6.91, p=0.038), artificial nutritional support requirement (odds ratio: 6.91, p=0.037) and overall survival (χ(2) =13.1, df=1, p=0.001).
  
  
  CONCLUSIONS
  Generalised oedema is common after emergency abdominal surgery and appears to independently predict gastrointestinal recovery, the need for artificial nutritional support and survival. Oedema is not associated with commonly applied markers of nutritional status such as body mass index or recent weight loss. Measurement of oedema offers utility in identifying those at risk of poor clinical outcome or those requiring artificial nutritional support following emergency abdominal surgery.
authors.affiliation: University Hospital Southampton NHS Foundation Trust, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Vaughan-Shaw
authors.forename: J
authors.initials: J
authors.lastname: Saunders
authors.forename: T
authors.initials: T
authors.lastname: Smith
authors.forename: A T
authors.initials: AT
authors.lastname: King
authors.forename: M A
authors.initials: MA
authors.lastname: Stroud
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D015992:Body Mass Index; D004487:Edema / Q000209:etiology*; D004638:Emergency Treatment / Q000379:methods* / Q000401:mortality; D006801:Humans; D045823:Ileus / Q000209:etiology; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D018529:Nutritional Support / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome
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