title: A Novel Approach to Major Surgery: Tracking Its Pathophysiologic Footprints.
abstract: BACKGROUND
  To study the 'metabolic profile' of different surgical procedures and correlate it with pertinent surgical details and postoperative complications.
  
  
  METHODS
  We conducted a prospective pilot study of 70 patients, ten for each of the seven following groups: (1) laparoscopic cholecystectomy, (2) incisional hernia repair, (3) laparoscopic and (4) open colon surgery, (5) upper gastrointestinal, (6) hepatic, and (7) pancreatic resections. Biochemical assessment included white blood cell count (WBC), C-reactive protein (CRP), glucose, triglycerides (TG), albumin (Alb), and pre-albumin (Pre-Alb), from the day before surgery until 5 days thereafter. Biological markers were compared for major versus minor surgery groups, which were defined on a clinical basis. Univariable analysis was used to identify risk factors for postoperative complications and p < 0.05 was the significance threshold.
  
  
  RESULTS
  Common findings in all surgery groups were the acute inflammatory response (↑: WBC, CRP, ↓: TG, Alb, pre-Alb). Using cut-off values of 240 min operative (OR) time and 300 ml estimated blood loss (EBL), laparoscopic cholecystectomy, incisional hernia repair, and laparoscopic colectomy could be distinguished from open colectomy, upper gastrointestinal, liver, and pancreas resections. In a biochemical level, increased CRP and reduced postoperative Alb levels were highly discriminative of all types of 'major surgery.' Significant risk factors for postoperative complications were age, male gender, malignancy, longer OR time, higher blood loss, high CRP, and low Alb levels.
  
  
  CONCLUSIONS
  Biochemically, CRP and Alb levels can help quantify the magnitude of the surgical trauma, which is correlated with adverse outcomes.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue Du Bugnon 46, 1011, Lausanne, Switzerland. styliani.mantziari@chuv.ch.
authors.forename: Styliani
authors.initials: S
authors.lastname: Mantziari
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue Du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.affiliation: Department of Clinical Nutrition and Metabolism, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Pauline
authors.initials: P
authors.lastname: Coti-Bertrand
authors.affiliation: Department of Clinical Nutrition and Metabolism, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Pralong
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue Du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Rue Du Bugnon 46, 1011, Lausanne, Switzerland. markus.schafer@chuv.ch.
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein