Postoperative depression of host resistance: Determinants and effect of peripheral protein-sparing therapy

N. V. Christou, R. Superina, M. Broadhead, J. L. Meakin

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48 Scopus citations

Abstract

A prospective study of 503 surgical patients with reactive delayed hypersensitivity skin test response to five recall antigens showed that 32 (6.4%) developed anergy in the postoperative period lasting longer than 1 week. The anergy group developed a 41% rate of sepsis (abscess or bacteremia) and had a 22% mortality rate, compared to 5% sepsis rate and 3% mortality rate in the reactive group. In the second part of this study, of 41 patients who underwent various surgical procedures from herniorrhaphy to esophagogastrectomy, we found that only major surgery (esophagogastrectomy, colectomy, aortic resection, etc.) caused 5% anergy in the immediate postoperative period. We thus evaluated the ability of peripheral protein-sparing amino acid therapy to correct this anergic state in the third part of this study. This was a prospective randomized evaluation of 85 surgical patients with reactive skin test response who were to undergo major surgery. Patients were skin tested before operation and on days 1, 3, 7, 14, and so on, following surgery. After operation they were randomized to receive 3000 ml/day of 5% casein hydrolysate (Amigen), 5% dextrose (0.34 calories/ml), or 3000 ml of isocaloric 10% dextrose in water (D10W) solution for 5 days, after which all patients were allowed food ad libitum. There was no difference in age, sex, preoperative albumin, total protein, white blood cell count, intraoperative blood loss or blood transfused, or volume of crystalloid received. There was no difference in daily postoperative fluids or calories infused in the two groups. The percentages of anergy in the D10W versus Amigen groups on postoperative days 1, 3, 7, and 14 were 41% versus 45%, 26% versus 16%, 15% versus 14%, and 6% versus 6% (NS x2 analysis). There was one episode of major sepsis and three deaths in D10W group and three episodes of sepsis and one death in the Amigen group. Minor sepsis rate (wound, urine) and therapeutic antibiotic utilization were the same. We conclude that there is a spontaneous evolution of postoperative surgically induced suppression of host resistance, and that this is not altered by protein-sparing therapy.

Original languageEnglish (US)
Pages (from-to)786-792
Number of pages7
JournalSurgery
Volume92
Issue number4
StatePublished - Dec 1 1982

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ASJC Scopus subject areas

  • Surgery

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