Elective abdominal surgery depresses muscle protein synthesis and increases subjective fatigue: effects lasting more than 30 days

Ten patients without metabolic disease undergoing elective cholecystectomy were studied before surgery and on days 3, 10, 20 and 30 after operation. Percutaneous muscle biopsies were taken and protein synthesis was determined from the total concentration and size distribution of ribosomes. The subjective feeling of fatigue was estimated using a visual analogue scale. The nitrogen balance was calculated at 20 days following surgery. The mean (s.e.m.) total concentration of ribosomes per milligram of DNA decreased by 27.5(6.6) per cent (P less than 0.01), 44.5(6.5) per cent (P less than 0.001), 48.3(8.9) per cent (P less than 0.001) and 45.0(8.2) per cent (P less than 0.01) on days 3, 10, 20 and 30, respectively. By 30 days after surgery no sign of restoration of normality was seen. The relative proportion of polyribosomes had decreased by 20.4(6.4) per cent (P less than 0.05) on the third postoperative day and by 20.4(3.9) per cent (P less than 0.01) on the tenth postoperative day and was restored to the preoperative level by day 20. The subjective fatigue score increased after operation and five of nine patients had not regained their preoperative scores 30 days after surgery. The daily nitrogen balance was negative for 5 days. The cumulated nitrogen losses were not restored until after 18 days following surgery. Elective abdominal surgery caused a sustained depression of protein synthesis for over 30 days, a longer period than previously presumed. These results show that long-term follow-up is required when the effect of different postoperative nutritional regimens are to be evaluated.