Risk Factors and Patient Outcomes Associated With Immediate Post-operative Anasarca Following Major Abdominal Surgeries: A Prospective Observational Study From 2019 to 2021

Satya P Meena; Metlapalli V Sairam; Ashok K Puranik; Mayank Badkur; Naveen Sharma; Mahendra Lodha; Mahaveer S Rohda; Nikhil Kothari

doi:10.7759/cureus.20631

Risk Factors and Patient Outcomes Associated With Immediate Post-operative Anasarca Following Major Abdominal Surgeries: A Prospective Observational Study From 2019 to 2021

Cureus. 2021 Dec 23;13(12):e20631. doi: 10.7759/cureus.20631. eCollection 2021 Dec.

Authors

Satya P Meena¹, Metlapalli V Sairam¹, Ashok K Puranik¹, Mayank Badkur¹, Naveen Sharma¹, Mahendra Lodha¹, Mahaveer S Rohda¹, Nikhil Kothari²

Affiliations

¹ General Surgery, All India Institute of Medical Sciences, Jodhpur, IND.
² Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, IND.

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.

Keywords: albumin; anasarca; clavien-dindo grading; edema; laparotomy; mortality.