title: Clinical utility of peri-operative C-reactive protein testing in general surgery.
abstract: BACKGROUND
  C-reactive protein (CRP) is an acute-phase protein used clinically to diagnose infectious and inflammatory disease and monitor response to treatment. CRP measurement in the peri-operative period was audited and patterns of change analysed for elective general surgical patients.
  
  
  METHODS
  General surgical patients (201) admitted for elective general surgery over a 3-month period were considered for the study. CRP results pre- and postoperatively were recorded, and data on co-morbid conditions and surgical procedure were noted.
  
  
  RESULTS
  CRP was requested pre-operatively on 84% of patients. A high CRP was more likely to be found in patients with co-morbidity. Postoperatively, CRP was requested during the first 3 days on 69% of patients. CRP peaked at postoperative days two or three, and then fell. In patients who had a high pre-operative CRP, the peak CRP was higher and occurred later, than those who had a normal pre-operative CRP.
  
  
  CONCLUSIONS
  CRP requesting pre-operatively is common, but is not recommended in NICE guidelines. Postoperatively, CRP levels rise; as a result, its use as a tool to screen for infection is limited. CRP has a role in diagnosis of infection after the first three postoperative days and in monitoring response to treatment. Therefore, routine use of CRP measurements pre-operatively and in the first 2 or 3 days post-operatively is not recommended. A peri-operative CRP should only be requested if there is a clear clinical indication.
authors.affiliation: Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, UK. duncan.cole@cardiffandvale.wales.nhs.uk
authors.forename: Duncan S
authors.initials: DS
authors.lastname: Cole
authors.forename: Andrew
authors.initials: A
authors.lastname: Watts
authors.forename: David
authors.initials: D
authors.lastname: Scott-Coombes
authors.forename: Tony
authors.initials: T
authors.lastname: Avades
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis*; D017558:Elective Surgical Procedures; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008485:Medical Audit; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D014852:Wales
chemical_list: D002097:C-Reactive Protein