Metabolic change in monocytes and postoperative morbidity after major abdominal surgery in elderly patients: A prospective cohort study

Yi Zhao; Mengchan Ou; Xuechao Hao; Tao Zhu

doi:10.1016/j.heliyon.2024.e28137

Metabolic change in monocytes and postoperative morbidity after major abdominal surgery in elderly patients: A prospective cohort study

Heliyon. 2024 Mar 22;10(7):e28137. doi: 10.1016/j.heliyon.2024.e28137. eCollection 2024 Apr 15.

Authors

Yi Zhao¹, Mengchan Ou¹, Xuechao Hao¹, Tao Zhu¹

Affiliation

¹ Department of Anesthesiology, and the Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Sichuan University, Chengdu, China.

Abstract

Background: Postoperative complications in aging patients remain a significant cause of increased costs, hospital length of stay, and patient distress. Although alterations in energy metabolism have been closely linked to aging process and surgery, it is still unclear whether metabolic changes during surgery is associated with postoperative complications in elderly patients. This study was conducted to investigate whether metabolic changes during surgery predicts postoperative complications in elderly patients.

Methods: We conducted a prospective single-center observational cohort study. 244 adults (aged ≥65 years) who were scheduled for elective major non-cardiac surgery were recruited. Blood samples for each patient were taken before and after surgery. All patients were randomly divided into two groups (122 in each group), then oxygen consumption rate (OCR) or extracellular acidification rate (ECAR) was measured on isolated monocytes in each group.

Results: 14 of 110 (12.7%) patients went through OCR measurement and 15 of 122 patients (12.3%) went through ECAR measurement experienced moderate to severe complications. Overall, there was an intensification of glycolysis in monocytes after surgery. Among all variables, only the change (preoperative -postoperative) of glycolytic reserve (GR)/glycolysis (G) and GR/non-glycolytic acidification (NG) were predictors of moderate to severe complications (AUC = 0.70; 95% CI, 0.56-0.81; P = 0.019 and AUC = 0.67; 95% CI, 0.55-0.80; P = 0.031). Decreased postoperative GR/G were associated with worse postoperative complications (RR = 9.08; 95% CI, 1.23-66.81; P = 0.024).

Conclusions: Compared with mitochondria function, the change of glycolytic function in monocyte was more valuable in predicting postoperative complications after major abdominal surgery. Our study gave us a new insight into identifying patients at high risk in aging patients.

Keywords: Abdominal surgery; Elderly patients; Metabolic change; Postoperative complications; Risk assessment.