Abstract
Introduction: Anasarca is well-known and refers to generalized edema caused by underlying clinical conditions and unknown risk factors in the patient. However, it is a relatively unexplored postoperative symptom following major abdominal surgeries. It is associated with poor patient outcomes in terms of delayed recovery and associated severe complications. Pedal edema is an early sign of post-operative anasarca, which progresses into an unfavorable clinical condition due to generalized edema followed by multiple organ dysfunction. Aim: This study aimed to assess risk factors and complications associated with postoperative anasarca among patients undergoing major abdominal surgery.Methods and material: The prospective observational study included 241 patients undergoing major abdominal surgeries from July 2019 to February 2021 in a tertiary care health centre in Rajasthan, India. Risk factors like age, nutritional parameters, addictions like smoking, alcohol intake, opium intake, leukocytosis, and Charlson Comorbidity Index were assessed. Postoperative complications were graded by the Clavien-Dindo grading system. Mean, standard deviation, percentages, Pearson’s Chi-square test and Student’s t-test were used to analyze the data. Results: The incidence of anasarca was found to be 29.87%. Nutritional risk screening (NRS) 2002 score, albumin, age > 60 years and raised leukocyte counts were found to significantly correlate (p-value <0.05) with the development of anasarca postoperatively. Postoperative complications, according to Clavien-Dindo grading, were 16.67% in grade I (p value=0.002), 13.89% in grade II (p-value =0.199), 1.39% in grade III (p value=0.049), 20.83% in grade IV (p value<0.001), and 41.67% in grade V (p value<0.001).Conclusion: Higher NRS 2002 score, low albumin levels, age > 60 years and raised leukocyte counts are significantly correlated with the development of postoperative anasarca. Postoperative anasarca is found to be a significant predictor of poor prognosis of patients undergoing major abdominal surgery.
Highlights
Anasarca is well-known and refers to generalized edema caused by underlying clinical conditions and unknown risk factors in the patient
Postoperative anasarca following abdominal surgery may be more prevalent in elderly age groups because the physiological safety mechanisms which protect against the formation of edema deteriorate with age
A higher Nutritional risk screening (NRS) 2002 score, lower albumin levels, higher age >60 years, and a higher leukocyte count are significantly correlated with the development of postoperative anasarca following major abdominal surgery
Summary
Anasarca is well-known and refers to generalized edema caused by underlying clinical conditions and unknown risk factors in the patient. It is a relatively unexplored postoperative symptom following major abdominal surgeries. It is associated with poor patient outcomes in terms of delayed recovery and associated severe complications. Previous works of literature have shown increased morbidity associated with postoperative edema following extra-abdominal surgery like plastic, maxilo-facial and orthopedic surgery. There are lacunae in the literature for risk factors associated with postoperative anasarca and related morbidity following abdominal surgery. This study aimed to assess postoperative anasarca, its incidence, risk factor and outcome of patients after major abdominal surgeries
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