The Factors associated with Systemic Inflammatory Response Syndrome 72 hours after Major Abdominal Surgery

Main Article Content

Permpen Noitun
Teeranut Harnirattisai
Chatchai Mingmalairak
Siriluck Kaewsriwong


This research of a descriptive design, aimed at studying the factors associated with systemic inflammatory response syndrome (SIRS) 72 hours after major abdominal surgery. Patients that had received major abdominal surgery were used in the study, and a total of 102 patients that met the inclusion criteria were studied. Data were collected between January and November, 2016. The instruments used were: 1) a Demographic Questionnaire; 2) a Pre-operative Physical Status Assessment; 3) the Nutrition Risk Index; 4) the Self-rating Anxiety Scale; 5) Surgical APGAR Scores; 6) Systemic Inflammatory Response Syndrome Scores and 7) a Postoperative Complication Form. The data were analyzed using descriptive statistics and Spearman’s rank correlation coefficient. The samples were males at 56.90% with an average age of 61.47 years (SD=13.25). The surgery treatments were gastrointestinal surgery at 55.90% and liver and biliary tract surgery at 44.10%. SIRS was found to occur in the patients postoperatively at a percentage of 55.90, 44.10, and 40.20 at 24, 48, and 72 hours after surgery respectively. Preoperative physical status and intraoperative status were found to be statistically significantly associated with SIRS within 72 hours. Nurses and healthcare teams can apply these findings to improve the quality of clinical nursing care, especially for monitoring SIRS and the factors related to pre-operative, and intraoperative postoperative phase in order to prevent life-threatening complications.
Keywords: Systemic inflammatory response syndrome, Nutrition, Anxiety, Intraoperative status, Major abdominal surgery


Download data is not yet available.

Article Details

How to Cite
Noitun P, Harnirattisai T, Mingmalairak C, Kaewsriwong S. The Factors associated with Systemic Inflammatory Response Syndrome 72 hours after Major Abdominal Surgery. Rama Nurs J [Internet]. 2017Sep.1 [cited 2020Feb.22];23(3):269-83. Available from:


1. Thanapaisal C.Endocrine and metabolic response to injury. In; Kitkhuandee A, et al. Text book of surgery 2. 1st ed. KhonKaen: Pen Printing 2008.

2. Buttenschoen K, Fathimani K, Buttenschoen DC. Effect of major abdominal surgery on the host immune response to infection. CurrOpin Infect Dis. 2010;23(3): 259-67.

3. Farinas-Alvarez C, Farinas MC, Fernandez-Masarraza C, Llorca J, Casanova D, Delgado-Rodriguez M. Analysis of risk factor for nosocomial sepsis in surgical patients [abstract]. BJS [Internet].2002;87(8) [cited 2014 October 20]. Available from: x/abstract

4. Toft P, Tønnesen E. The systemic inflammatory response to anesthesia and surgery. Current Anesthesia & Critical Care. 2008;19:349-53.

5. Haga Y, Beppu T, Doi K, Nozawa F, Mugita N, Ikei S, et al. Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med. 1997;25(12):1994-2000.

6. Talmor M, Hydo L, Barie PS. Relationship of systemic inflammatory response syndrome to organ dysfunction, length of stay, and mortality in critical surgical illness. Arch Surg. 1999;134:81-7.

7. Singh S, Singh P, Singh G. Systemic inflammatory response syndrome outcome in surgical patients. Indian J Surg. 2009;71(4):206-9.

8. Ferraris VA, Ballert EQ, Mahan A. The relationship between intraoperative blood transfusion and postoperative systemic inflammatory response syndrome. Am J Surgery. 2013; 205:457-65.

9. Tønnesen H, Nielsen PR, Lauritzen JB, Møller AM. Smoking and alcohol intervention before surgery: evidence for best practice. Br J Anaesth. 2009;102(3):297-306.

10. Punjasawadwong Y, Hintong, T. The Thai anesthesia incidents study (THAI Study) of anesthetic adverse events and risk factors for preventive strategies. Multicenter collaboration research in Thailand; 2005.(in Thai)

11. Jakobson T, Karjagin J, Vipp L, Padar M, Parik AH, Starkopf L, et al. Postoperative complications and mortality after major gastrointestinal surgery. MEDICINA [Internet]. 2014;50 [cited 2015 Jan 25]. Available from 0660X14000196

12. Kulpho Y, Thosingha O, Danidutsadeekul S, & Kongsayareepong S. Predictive factors for systemic inflammatory response syndromes during the first 24 post-operative hours in abdominal surgery patients. Thai Journal of Nursing Council. 2014;29(1):5-14.(in Thai)

13. Panoi A, Kasemmongkol J. Prevalence of preoperative malnutrition in major abdominal surgery patients. Royal Thai Army Medical Journal. 2004;57(2):69-76.(in Thai)

14. Krisanabud P, Thosingha O, Danaidutsadeekul S, Iramaneerat C. Factors associated with recovery among patients undergoing non-traumatic general abdominal surgery within one week. Thai Journal of Nursing Council. 2012;27(1);39-48. (in Thai)

15. Putwatana P, Reodecha P, Sirapo-ngam Y, Lertsithichai P, Sumboonnanonda K. Nutrition screening tools and the prediction of postoperative infectious and wound complications: comparison of methods in presence of risk adjustment. Nutrition. 2004;21:691-7.(in Thai)

16. Zhou W, Xu X, Yan J, &Mou Y. Nutritional risk is still a clinical predictor of postoperative outcomes in laparoscopic abdominal surgery. SurgEndosc. 2013;8:27.

17. Hassen TA, Pearson S, Cowled PA, Fitridge RA. Preoperative nutritional status predicts the severity of the systemic inflammatory response syndrome (SIRS) following major vascular surgery. Eur J Vas EndovascSurg [Internet]. 2007;33:696-702.doi:10.1016/j.ejvs.20 06.12.006

18. Yusamran M,Sripontan P. Percieved anxiety level and it’s causes in the pre-operative patients at Mahasarakam hospital. J SciTechnol MSU. 2014;418-28.(in Thai)

19. Maes M, Song C, Lin A, De Jongh R, GastelAV, Kenis G, et al. The effects of psychological stress on human: increased production of pro-inflammatory cytokines and Th1-like response in stress-induced anxiety [abstract]. Cytokine[Internet]. 1998;10(4) [cited 2015 Feb 19]. Available from

20. Nathens A, Maier R. Shock and resuscitation. In; Norton J, Barie P, Bollinger RR, Chang A, Lowry S, Mulvihill S, Pass H, Thompson R (Eds). Surgery. Springer New York; 2008, p. 305-321

21. Haynes AB, Regenbogen SE, Weiser TG, Lipsitz SR, Dziekan G, Berry WR, et al. Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries. Surgery. 2011;149(4):519-24.

22. Rogenbogen SE, Bordeianou L, Hutter MM, Gawande A. The intraoperative surgical apgar score predicts postdischarge complications after colon and rectal resection. Surgery. 2010;148:559-66.

23. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3.0.10 [Internet]. 2008 (cited 2013 Jan 4). Available from

24. Burns N, Grove S. The practice of nursing research: conduct, critique, and utilization. 4thed. Philadelphia, Pennsylvania, USA: W.B. Saunders; 2001.

25. American Society of Anesthesiologists. ASA physical status classification system (last approved by the ASA House of Delegates on October 15, 2014) [Internet]. 2014 [cited 2014Dec 14]. Available from

26. Fuller JK, Anesthesia. In Fuller JK. Surgical technology principles and practice. 4th ed. Missouri: Elsevier Saunders 2005;215-43.

27. Buzby GP, Knox LS, Crospy LO, Eisenberg JM, Hakenson CM, Mcneal GE et al. Study protocol: a randomized clinical trialof total parenteral nutrition in malnourished surgical patients. Am J ClinNutr.1988;47:366-81.

28. William WK Zung. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371-9.

29. Thammaraksa S. The effect of biofeedback training and autogenic training programs towards anxiety levels of patients who are facing with anxiety. [thesis]. PathumThani: Thammasat University; 2008. (in Thai)

30. Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An apgar score for surgery. American College of Surgeons, 2007;204(2):201-8.

31. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med .1992;20(6): 864-74.

32. Plevkova J. Systemic inflammatory response syndrome. [Internet]. 2011[cited 2014 October 7]. Available from 75b3c48230a1b749cea02e361b6f/ Systemic-inflammatory-response-syndrome-2011.pdf

33. Tschoeke SK, Hellmuth M, Hostmann A, Ertel W, OberholZer A. The early second hit in trauma management augments the pro-inflammatory immune response to multiple injuries. J Trauma. 2007;62(6):1396-1404.

34. Oh CA, Kim DH, Oh SJ, Choi MG, Noh JH, Sohn TS, et al. Nutrition risk index as a predictor of postoperative wound complications after gastrectomy. World J Gastroenterol. 2012;18(7):673-8.

35. Thieme RD, Cutchma G, Chieferdecker MM, Campos ACL. Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall?. ABCD: Arq Bras Cir Dig [Internet]. 2013;26(4) [cited 2015 Jan 17]. Available from