DEVELOPMENT OF POSTOPERATIVE INSULIN-RESISTANCE IS ASSOCIATED WITH THE MAGNITUDE OF OPERATION

Objective: To study the development of insulin resistance and changes in stress hormone concentrations in patients undergoing elective opera tions of different magnitude. Design: Prospective open study. Setting: University hospital, Sweden. Subjects: 12 otherwise healthy patients undergoing elective surgery for cholecystectomy (n = 6) and inguinal h ernia repair (n = 6). Interventions: Insulin sensitivity was measured by the normoglycaemic, hyperinsulinaemic glucose clamp technique befor e operation (control) and on the first postoperative day. Main outcome measure: Relative insulin sensitivity (compared with preoperative) on the day after each operation. Changes in stress hormone concentration s in relation to the relative change in insulin sensitivity. Results: After hernia repair, mean (SEM) insulin sensitivity was reduced by 32 (4)%, p < 0.05 compared with baseline, and after open cholescystectomy by 56 (3)%, (p < 0.05). The difference between the two groups was hig hly significant (p < 0.01). The changes in concentrations of catechola mines, glucagon, cortisol and growth hormone after operation were only small, and did not correlate with the relative changes in insulin sen sitivity. Conclusions: Insulin resistance develops even after a minor elective operation, (inguinal hernia repair). The degree of postoperat ive insulin resistance was more pronounced after open cholecystectomy. The alterations in insulin sensitivity could not be related to simult aneous changes in the hormones studied.