Analysis Of Cytokine Concentration And The Visual Analogue Pain Scale Score As Early Indicators Of Sepsis In Gall Stone Disease Patients Evaluating Quality Of Life Questionnaires To Determine Which Patients Will Experience Significant Pain After Intervention
thesisposted on 2019-09-04, 10:41 authored by Rachel Soulsby
Introduction: Sixty thousand cholecystectomies are performed each year (Royal College of Surgeons, 2016). Unplanned admissions occur after 10% procedures secondary to complications and pain (Chandio et al., 2017). This study aimed to identify whether pain was an early indicator of post-procedural sepsis, permitting earlier treatment to reduce morbidity. To successfully do this required identifying these patients, from patients who experienced a lot of pain postoperatively but did not develop sepsis, and were unsuitable for day-case surgery. Methods: Three hundred and ninety six patients with biliary disease were recruited. Participant’s systemic TNF-α, IL-1, IL-6 and IL-10 concentration was measured by ELISA techniques. They were compared to their systemic inflammatory response syndrome (SIRS) markers, and visual analogue score pain assessment. SF-36 and the Gastrointestinal quality of life index were chosen to measure quality of life, after a literature review indicated poorer quality of life scores pre-operatively indicated patients who did not benefit as greatly from cholecystectomy and continued to experience pain. Results: The VAS score was significantly higher from six hours onwards in those developing sepsis compared to those who did not after ERCP or cholecystectomy. In contrast the inflammatory cytokines peaked at 24 hours in the open and ERCP patients, and at 48 hours in the laparoscopic approach patients developing sepsis. The peak in the SIRS markers coincided with the cytokine peak for each approach. The quality of life measures permitted us to distinguish a group of patients whoexperienced a lot of pain post-operatively but did not develop sepsis, from those whose increase in pain was an indicator of sepsis. The group of patients with pain notdeveloping sepsis were unlikely to be suitable for day case surgery, being unlikely to be discharged at 24 hours, and less likely to benefit from cholecystectomy. Conclusion: Both for laparoscopic and open cholecystectomy pain is an early indicator of potential postoperative sepsis, preempting the rise in cytokines and SIRS. The VAS with the quality of life measures permitted the identification pre-operatively of a patient group unsuitable for day case cholecystectomy. Earlier recognition and treatment of sepsis would promote improved patient outcome. Heterogeneity of causes of sepsis and small number of cases limits conclusions, and this requires a multi-centre study.
Date of award2019-08-07
Author affiliationDepartment of Cardiovascular Sciences
Awarding institutionUniversity of Leicester