The association of early postoperative lactate levels with morbidity after elective major abdominal surgery

  • Jelena Veličković Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
  • Ivan Palibrk Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
  • Biljana Miličić Institute for Informatics and Statistics, School of Dentistry, University of Belgrade, Belgrade, Serbia
  • Dejan Veličković Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
  • Bojan Jovanović Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
  • Goran Rakić Department of Emergency Medicine, School of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Milorad Petrović Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
  • Vesna Bumbaširević Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
Keywords: Elective surgery, major abdominal surgery, lactate, postoperative complications, in-hospital mortality, surgical intensive care

Abstract

Lactate levels are widely used as an indicator of outcome in critically ill patients. We investigated the prognostic value of postoperative lactate levels for postoperative complications (POCs), mortality and length of hospital stay after elective major abdominal surgery. A total of 195 patients were prospectively evaluated. Lactate levels were assessed on admission to the intensive care unit (ICU) [L0], at 4 hours (L4), 12 hours (L12), and 24 hours (L24) after the operation. Demographic and perioperative clinical data were collected. Patients were monitored for complications until discharge or death. Receiver operating characteristic (ROC) curves were used to determine the predictive value of lactate levels for postoperative outcomes. The best cut-off lactate values were calculated to differentiate between patients with and without complications, and outcomes in patients with lactate levels above and below the cut-off thresholds were compared. Univariate and multivariate analyses were used to identify variables associated with POCs and mortality. Seventy-six patients developed 184 complications (18 deaths), while 119 had no complications. Serum lactate levels were higher in patients with complications at all time points compared to those without complications (p < 0.001). L12 had the highest predictive value for complications (AUROC12 = 0.787; 95% CI: 0.719–0.854; p < 0.001) and mortality (AUROC12 = 0.872; 95% CI: 0.794–0.950; p < 0.001). The best L12 cut-off value for complications and mortality was 1.35 mmol/l and 1.85 mmol/l, respectively. Multivariate analysis revealed that L12 ≥ 1.35 mmol/l was an independent predictor of postoperative morbidity (OR 2.58; 95% CI 1.27–5.24, p = 0.001). L24 was predictive of POCs after major abdominal surgery. L12 had the best power to discriminate between patients with and without POCs and was associated with a longer hospital stay.

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Author Biographies

Jelena Veličković, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
Department of Surgery and Anesthesia
Ivan Palibrk, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
Department of Surgery and Anesthesia
Dejan Veličković, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
Department of Surgery and Anesthesia
Bojan Jovanović, Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
Department of Surgery and Anesthesia
Goran Rakić, Department of Emergency Medicine, School of Medicine, University of Novi Sad, Novi Sad, Serbia
Department of Emergency Medicine
Milorad Petrović, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia
Department of Surgery and Anesthesia
Vesna Bumbaširević, Department of Surgery and Anesthesia, School of Medicine, University of Belgrade, Belgrade, Serbia Center for Anesthesia and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
Department of Surgery and Anesthesia
Published
2019-02-12
How to Cite
1.
Veličković J, Palibrk I, Miličić B, Veličković D, Jovanović B, Rakić G, Petrović M, Bumbaširević V. The association of early postoperative lactate levels with morbidity after elective major abdominal surgery. Bosn J of Basic Med Sci [Internet]. 2019Feb.12 [cited 2019Dec.9];19(1):72-0. Available from: http://www.bjbms.org/ojs/index.php/bjbms/article/view/3186
Section
Translational and Clinical Research