Determination of the Stress Factor Calculated from the Changes in the Measured Resting Energy Expenditure with Indirect Calorimetry in Patients Undergoing Pancreaticoduodenectomy

Abstract

Purpose: To predict the energy expenditure using the stress factor representing the ratio of the metabolic variation between pre-operation and post-operation in a pancreaticoduodenectomy (PD). Methods: This was a prospective study conducted on 17 patients (11 males and 6 females) who underwent PD at Chonbuk National University Hospital between March 2010 and October 2011. The rest energy expenditure was measured by indirect calorimetry 1 day before and 3 days after surgery. The height, weight, and fat free mass were also measured 1 day before surgery. Results: The mean measured rest energy expenditure 1 day before PD (mREE pre ) and 3 days after PD (mREE post ) were significantly different (16.8±2.6 vs. 18.8±3.5 kcal/kg/d, P=0.0076). The stress factor, representing the ratio of the metabolic changes between pre-and post-PD, was 1.12±0.17. The recommended energy requirement for PD patients is estimated to be 23∼24 kcal/ideal body weight/d [determined from the measured preoperative rest energy expenditure (16.8±2.6 kcal/kg/d)×activity factor (1.2∼ 1.3)×stress factor (1.12)]. Conclusion: PD patients maintained a hypermetabolic status and the applicable stress factor was 1.12.

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“…And they found that all parameters were lowest at POD 5 [17]. Kim [11] also observed significant differences in levels of prealbumin, CRP, and TLC between 1 day before and 3 and 7 days after PD surgery. Park et al [9] showed that serum transferrin, Alb and TP levels were the lowest at the day of leaving hospital after pancreatobiliary surgery.…”

“…These values are quite low comparing to values from other studies. Kim [11] reported that the average energy intake by POD 3 from PN and oral intake was 1,050 kcal/day after PD surgery. Hwang et al [23] studied the effect of early postoperative enteral nutrition on postoperative outcomes and reported that the mean of daily calorie and protein intake in the early oral feeding group (847.0 kcal and 42.4 g, respectively) were significantly higher than those in the traditional oral feeding group.…”

“…Kim [11] reported that energy intake via oral and intravenous injection approximates to 1,050 kcal/day in a group with postoperative PD patients. Enhanced recovery after surgery study also reported that adherence to postoperative targets was inappropriate: 55% for oral liquids and solid 53% for food [12].…”