Impaired Recovery of Strength in Older Patients After Major Abdominal Surgery

Abstract

Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.

Body Composition, Muscle Function and Psychological Changes in Patients Undergoing Operation for Hepatic or Pancreatic Disease

“…This is consistent with the observed decline in total body protein as shown by the fall in MAC. In another study of 40 patients undergoing major abdominal surgery, postoperative maximum grip strength was most markedly reduced 2 days after surgery [18]. These changes are similar to results seen in our study and suggest that impairment in voluntary muscle function occurs very soon after operation and remains low for at least a week.…”

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial

“…Surgical injury provokes a stress response that leads to a high catabolic state with hyperglycemia and increased oxidation of body protein [20], which is characterized by a state of insulin resistance [21] and can interfere with the postoperative recovery process [22,23]. In recent years, some perioperative protocols, including preoperative oral carbohydrate [24], epidural analgesia, early nasogastric tube removal, and early feeding with a low-fat liquid diet, have all aimed at suppressing perioperative stress to achieve a faster recovery from surgery and a quicker hospital discharge of patients [19].…”

Perioperative catabolism

“…51,52 The ensuing muscle weakness prolongs mechanical ventilation, inhibits coughing, and impedes mobilization, thereby causing morbidity and complicating convalescence. 53,54 The length of time for return of normal physiologic function after discharge from the hospital is related to the extent of lean body loss during hospitalization. 54 Significant mortality occurs after critically ill patients are discharged from the intensive care unit (ICU) and hospital.…”