Early rise in C-reactive protein is a marker for infective complications in laparoscopic colorectal surgery.
BACKGROUND
Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications.


METHODS
Between July 2010 and June 2012, 169 patients underwent elective laparoscopic colorectal surgery. Daily postoperative CRP was measured until discharge and infective complications were observed.


RESULTS
A total of 169 patients underwent laparoscopic colorectal surgery. Twenty-one (12.4%) had infective complications, 6 (3.6%) had anastomotic leaks. There was a significant difference in CRP levels between those with infective complications and those without infective complications on postoperative days 3 and 5 (day 3 postop, P=0.0001; day 5 postop, P=0.0001). Of those with infective complications, there was a significant difference between CRP levels when comparing preoperative levels with those on day 3 and day 5 (preoperative vs. day 3, P=0.0001; preoperative vs. day 5, P=0.0003). A raised CRP is a predictor of infective complication from day 3 (odds ratio 1.012, P<0.001) where as white cell count is not an accurate predictor. A CRP cutoff of 148 on day 3 provided the highest sensitivity and specificity of predicting infective complications, 86% and 77%, respectively.


CONCLUSIONS
CRP is effective as an early predictor of infective complications after laparoscopic colorectal surgery and may be a useful adjunct in conjunction with an enhanced recovery program in reducing morbidity. A CRP of >148 mg/mL on postoperative day 3 or a persistently elevated CRP should heighten clinical suspicion of an infective complication.
Department of Surgery, Division of Colorectal Surgery, Adelaide and Meath (incorporating the National Children's) Hospital, Tallaght, Dublin, Ireland.
Gregory J
GJ
Nason
Brian D
BD
Barry
Obinna
O
Obinwa
Eamon
E
McMacken
Nigel S
NS
Rajaretnam
Paul C
PC
Neary
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D003108:Colonic Diseases / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology / Q000378:metabolism*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D002097:C-Reactive Protein