Predictor of Postoperative Complications After Lengthy Surgical Procedures

Study Overview
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Brief Summary
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Many patients undergoing long time surgery will manifest increased level of blood lactate. Hyperlactacidemia can cause disturbance of internal environment, then leading to increased complications and longer ICU stay, even death. For postoperative patients, we must ensure adequate perfusion in order to minimize the length of hyperglycemia and improve patients' outcomes. With regard to lactate, it provides information about prefusion, but not timely enough for its delay on reflecting hypoperfusion. And it's not real-time and non-invasive. Peripheral perfusion index (PPI) is an indicator reflecting hypoperfusion in critical patients. It is measured using pulse co-oximetry technology which is characterized by being real-time and noninvasive. PPI is defined as the ratio of pulsatile blood flow to the non-pulsatile blood flow, mirroring the strength of blood flow and quality of perfusion at sensor site, reflecting perfusion state of the body part . In contrast to lactate value, it's real-time and easy to monitor.

Official Title
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Peripheral Perfusion Index Versus Serum Lactate Levels as Predictor of Postoperative Complications and Prolonged ICU Stay After Lengthy Surgical Procedures: a Prospective Observational Study

Conditions
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Peripheral Perfusion Index

Intervention / Treatment
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* Diagnostic Test: Peripheral Perfusion index
* Diagnostic Test: serum lactate level


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Adult patients above 18 years of age. Both genders surgical time planned to be > 120 minutes . surgical time predicted to exceed the planned time and prolongation of surgical time > 120 minutes occured will be included in the study . ASA physical status of I-III Patients scheduled for elective surgery under general anaesthesia . Exclusion criteria Refused to participate . ASA physical status of IV . patient with disease affecting blood flow to the hands where probe will be applied . patient with hand injuries so probe cannot be applied Patient with sever renal and liver disease Discharging against medical advice or reported death during ICU stay at first 48 hours after ICU admission . Pregnancyor emergency surgery . shortening of the planned surgical time to be less than 120 minutes due to a surgical factor for example irrespectability or other causes .

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Non-severe complications group<br>where the non-complicated patients is the patients running the normal postoperative course of surgery and without any need for intervention | Diagnostic Test: Peripheral Perfusion index<br>* Peripheral Perfusion index is the ratio between pulsatile blood flow to non pulsatile blood flow or static blood in the peripheral tissue<br>Diagnostic Test: serum lactate level<br>* Blood lactate (product of metabolism) level is maintained by a cycle of continuous production and metabolism allowing it to be kept within normal values<br>|
| severe complications group<br>any deviation from the normal post-operative course | Diagnostic Test: Peripheral Perfusion index<br>* Peripheral Perfusion index is the ratio between pulsatile blood flow to non pulsatile blood flow or static blood in the peripheral tissue<br>Diagnostic Test: serum lactate level<br>* Blood lactate (product of metabolism) level is maintained by a cycle of continuous production and metabolism allowing it to be kept within normal values<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| serum lactate level | at end of surgery as early predictor of postoperative complications . | UP TO 1 HOURE | 
| Peripheral perfusion index | at end of surgery as early predictor of postoperative complications . | UP TO 1 HOURE | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of ICU stay | BY DAY | UP TO 30 DAY | 
| hospital stay length | BY DAY | UP TO 30 DAY | 
| duration of surgical time | MIN | UP TO 24 HOURE |