ASSESSMENT OF SURGICAL STRESS RESPONSE AND PREDICTING ITS FUNCTIONAL IMPLICATIONS

Surgery alters the homeostatic balance and defence mechanisms in body eliciting certain responses called as stress response. In addition certain peri-operative factors may also influence the degree of stress response reflecting surgical recovery. The present study is an attempt to assess surgical stress response and to determine the influence of peri-operative factors on it. This study investigates the effects of surgery on early non specific immune and endocrine responses. 100 subjects undergoing minor and major elective surgeries were studied. Blood samples were collected before, immediately after and 72 h after the surgery. Total WBC count, differential neutrophil count, random blood sugar and pulse rate were assessed. Pain (Allina scale) and Depression Anxiety Stress scale (DAS) were used for evaluating the relation to stress response. In addition we used Estimation of Physiological Ability and Surgical Stress (E-PASS) scoring system for predicting the risk of post operative complications by quantifying patients reserve and degree of surgical stress. In minor surgeries, there was no significant drop in total counts after surgery, whereas in major surgery total count was decreased. In both the surgeries, the percentage of neutrophil count increased immediately after surgery but later dropped to less than preoperative count after 72 h and blood sugar levels were also found to be elevated in early post operative period. We observed a great relation between the pain and psychological stress to surgical recovery. Thus we suggest considering peri-operative management as a clinical significance to improve patient safety and care.