Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Abstract

BackgroundPerioperative serum potassium levels are closely associated with postoperative clinical outcomes after gastrointestinal surgery. The aim of our retrospective study was to identify the prevalence and risk factors for preoperative hypokalemia (before pneumoperitoneum) and to evaluate the influence of preoperative hypokalemia on the recovery of postoperative gastrointestinal function.MethodsIn this retrospective study, patients scheduled for laparoscopic colorectal resection from November 11 2014 to October 20 2016, were considered for inclusion. A blood potassium level between 3.5 and 5.5 mmol/L was defined as normal, with levels between 3.0 to 3.5 mmol/L, 2.5 to 3.0 mmol/L and < 2.5 mmol/L considered as slight, moderate, and severe level of hypokalemia. The factors including age, gender, ASA grade, BMI, hypertension, diabetes, anti-hypertension drugs, lactose oral soluble, oral cathartics, oral cathartics, cathartic enemas, and blood potassium level before gastrointestinal preparation which might be associated with blood potassium level before pneumoperitoneum were analysed. The time to postoperative first flatus (FFL) and first feces (FFE) was compared between patients with and without hypokalemia.ResultsThe final analysis was based on the data of 108 patients. Hypokalemia was identified in 70.37% patients, with the following distribution of blood potassium levels before pneumoperitoneum: slight, 49 (45.37%) patients; moderate, 23 (21.30%); and severe, 4 (3.70%) patients. Hypokalemia was significantly associated with hypertension and the use of ≥2 types of oral cathartics for preoperative gastrointestinal preparation. With treatment, potassium levels recovered to normal levels in all patients within 48 h postoperatively. Hypokalemia was associated with a longer postoperative time to first feces, compared to patients with a normal potassium level before pneumoperitoneum.ConclusionsOur findings underlie the importance of early monitoring and management of serum potassium levels in these patients.

Effects of preoperative oral carbohydrate electrolyte drinks on preoperative hypokalemia incidence in patients scheduled for laparoscopic colorectal resection: a randomized clinical trial

“…Our retrospective study demonstrated that preoperative hypokalemia prolonged postoperative time to FFE but not the time to FFL. [8] Several randomized controlled clinical trials have demonstrated that preoperative oral carbohydrates and oral rehydration solutions do not improve the quality of recovery in either minimally invasive body surface surgery or major abdominal surgery [22][23][24] The present study showed that oral carbohydrate drinks with and without 1 g of potassium administered 2-3 h before anesthesia induction did not improve the postoperative outcomes. Several factors might account for it.…”

“…Potassium levels between 3.0 and 3.5 mmol/L, more than 2.5 and less than 3.0 mmol/L, and less than 2.5 mmol/L were considered as slight, moderate, and severe hypokalemia, respectively. [8] Pre-anesthesia thirst (0, no thirst; 10, unbearable thirst), hunger (0, no hunger; 10, unbearable hunger), flavor (0, unbearable flavor; 10, tasty flavor), and anxiety scores (0, no anxiety; 10, high anxiety) were assessed using a visual analog score based on that of a previous study. [10] The other outcomes included postoperative gastrointestinal function, the time to postoperative first flatus (FFL) and first feces (FFE) and other complications.…”

“…Hypokalemia is common in hospitalized patients; approximately 20% of inpatients experience hypokalemia[16] Perioperative hypokalemia is even higher in patients scheduled for laparoscopic colorectal resection. [8] Bowel preparation combined with systemic antibiotics is effective in reducing the incidence of surgical site infection in colorectal surgery. [17] Therefore, bowel preparation is recommended in the ERAS protocol for patients scheduled for rectal resection.…”

“…[7] In our previous study, the hypokalemia incidence was as high as 70%. [8] The clinical symptoms depend on the severity of hypokalemia. Severe hypokalemia would lead to disorders of various systems including lethal heart arrhythmias, respiratory failure, constipation or intestinal paralysis [19].…”

“…Nevertheless, no study has been conducted on preoperative potassium management in patients scheduled for laparoscopic colorectal resection, whose preoperative hypokalemia incidence was found to be high in our previous study. [8] Although oral administration is commonly recommended for prophylactic potassium supplement, a previous study demonstrated that use of the oral route is extremely rare. [9] Therefore, adding potassium to preoperative fluids might be a useful choice.…”