Monitoring c-reactive protein after laparoscopic colorectal surgery excludes infectious complications and allows for safe and early discharge.
Surg Endosc
; 28(10): 2939-48, 2014 Oct.
Article
in En
| MEDLINE
| ID: mdl-24853848
ABSTRACT
BACKGROUND:
Early detection of infectious complications is urgently needed in the era of DRG-based compensation. This work assessed the diagnostic accuracy of c-reactive protein (CRP) level in the detection of infectious complications after laparoscopic colorectal resection.METHODS:
Laparoscopic colorectal resections were identified from a prospective database. Complications were graded according to the Dindo-Clavien classification. Surgical site infections were defined according to the Centers of Disease Control. CRP level was routinely measured until postoperative day (POD) 7. Uni- and multivariate analysis were performed. Diagnostic accuracy was evaluated using receiver operating curves.RESULTS:
355 patients were operated for diverticulosis (88.7%), neoplasia (6.8%), and other causes (4.5%). Mean age and body mass index were 59.8 ± 13.7 years and 26.5 ± 15 kg/m(2). Left, right, and total laparoscopic colectomies were performed in 316, 33, and 6 patients. Complications occurred in 85 patients and 16 patients (4.5%) were reoperated. Fifty-one patients (14.4%) suffered from infectious complications at a median of 6 POD, while 9 anastomoses leaked (2.7%). In multivariate analysis, presence of an abscess at surgery was predictive of an infectious complication (OR 2.5, 95% CI 1.1-5.3), as were a body mass index >30 kg/m(2) and operative time >160 min in a bootstrap analysis. Overall, CRP peaked on POD 2 and declined thereafter. Most infectious complications were apparent starting on POD 6. A CRP <56 mg/l on POD 4 had a negative predictive value of 100% (95% CI 94.9-100%) to rule out infectious complications. Above 56 mg/l, sensitivity was 100% (95% CI 0.8-1) and specificity 49% (95% CI 0.4-0.6) for the development of infectious complications in the absence of clinical signs. This translated into a remarkable diagnostic accuracy of 78% (95% CI 0.7-0.9).CONCLUSION:
Monitoring CRP level in laparoscopic colorectal surgery demonstrated a high diagnostic accuracy for infectious complications, thus allowing for safe and early discharge.
Full text:
1
Database:
MEDLINE
Main subject:
Rectal Diseases
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C-Reactive Protein
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Cross Infection
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Laparoscopy
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Colonic Diseases
/
Length of Stay
Type of study:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
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Screening_studies
Limits:
Aged
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Female
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Humans
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Male
/
Middle aged
Language:
En
Year:
2014
Type:
Article