Assessing and reducing severity of perioperative stress response to emergency surgery in patients with acute cholecystitis

Aim. To explore the possibilities for assessing and reducing the severity of perioperative stress response to emergency surgery in patients with acute cholecystitis.

Materials and methods. 207 patients with acute cholecystitis were registered from January 2017 to January 2019. Patients were randomized into groups. Enhanced recovery techniques were used in the main group. Cortisol and Interleukin-6 levels were measured to examine the perioperative stress response and to identify biochemical predictors of complications associated with acute cholecystitis.

Results. The groups did not reveal a statistically significant difference in the number of postoperative complications. The length of postoperative stay was shorter in the main group (33.3 ± 19.6 h and 53.7 ± 32.7 h; p < 0.0001). Within 24 postoperative hours, 54.5% of patients in the main group and 19.8% of the control group were discharged from hospital. Early mobilization and enteral feeding reduced the time of return to physical activity and transition to habitual diet in the main group, which was also noted with a lower incidence of postoperative pain in the shoulder and/or neck: 12 (13.6%) compared to 35 (34.7%) observations. The application of the enhanced recovery protocol provided no significant effect on postoperative cortisol levels in the main group.

Conclusion. In surgical patients with acute cholecystitis, enhanced recovery improves the quality of the postoperative period, reducing the severity and frequency of postoperative pain, phrenicus and dyspepsia symptoms. The enhanced recovery techniques diminish the length of hospital stay without increasing the incidence of complications and re-hospitalizations.

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