Influence of insulin resistance on postoperative period course in patients after colonic anastomosis

Abstract

Aim – to determine the influence of insulin resistance (IR) on the development of postoperative complications in patients after application of colon anastomosis (CA). Materials and methods. In order to determine the effect of IR on the postoperative period in patients after CA, 80 patients aged between 24 and 82 years (age – 63.41 (57.00; 71.50) years) were examined and operated, among them 29 (36.25 %) men and 51 (63.75 %) women). Group 1 consisted of 40 patients with insulin resistance (IR) (age of patients - 65.00 (57.00; 75.00) years). Group 2 - 40 patients without IR (age of patients - 62.00 (56.00; 67.00) years). Postoperative complications, carbohydrate and lipid metabolism, levels of systemic inflammation markers and adipocytokines were analyzed. Results. IR resulted in a significant increase in the incidence of purulent-inflammatory changes in the postoperative wound area as compared to patients without IR (12 vs. 4, respectively) (χ2 = 5.00, df = 1; P < 0.05). It was found that in patients with IR, a significant increase (P < 0.05) in body mass index by 6.80 %, waist circumference by 4.65 % was observed, higher blood insulin levels, values of NOMA-IR index, NOMA 2 index and NOMA-β-cell index by 3.42, 3.47, 3.01 and 3.32 times, respectively, as well as triglycerides levels (by 26.2 %), CRP concentrations (2.14 times), resistin and TNF-α levels (by 51.72 % and 36.51 %, respectively). The role of IR in the activation of systemic inflammation and adipocytokine imbalance has been proven by a correlation relationship between HOMA index and both resistin and TNF-α, as well as between insulin metabolism markers and visceral obesity indices. Conclusions. Insulin resistance leads to an increase in purulent-inflammatory complications incidence in patients with colonic anastomosis. The presence of insulin resistance is accompanied by a significant aggravation of lipid disorders and proinflammatory blood changes, and its severity increases in parallel with the progression of visceral obesity indices

Keywords

• visceral obesity indices insulin resistance
• colon
• anastomosis
• surgical
• postoperative period