title: Diagnostic markers of postoperative morbidity after laparoscopic Roux-en-Y gastric bypass for obesity.
abstract: OBJECTIVE
  The main objective of this study was to detect subacute complications that can arise from laparoscopic Roux-en-Y gastric bypass and take a rational approach to manage these complications.
  
  
  METHODS
  A prospective observational study was performed from November 2010 to December 2012. All patients undergoing gastric bypass surgery for morbid obesity were included in this study. Patients with complications before day 5 were excluded from the study. Clinical and laboratory data (C-reactive protein, leukocyte count) at postoperative day 5, 30-day morbidity, were recorded. The diagnostic value of C-reactive protein (CRP) and leukocytes were determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  One hundred and twenty-six patients were included. The overall incidence of 30-day morbidity was 8.7 %, and anastomotic leakage rate was 3.2 %. C-reactive protein at postoperative day 5 was a good predictor of complications (AUC was 0.862 (95 % CI [0.76; 0.96]; p < 0.001) and anastomotic leakage (AUC was 0.863 (95 % CI [0.66; 1]; p = 0.014). A CRP cutoff level of 136 mg/l at postoperative day 5 yielded a specificity of 95.5 % and a sensitivity of 57.1 % for the detection of postoperative complications. The negative predictive value was 94.6 %. A CRP level of 136 mg/l at day 5 was significantly associated with postoperative morbidity.
  
  
  CONCLUSIONS
  C-reactive protein dosage at postoperative day 5 is a relevant predictor of postoperative complications permitting to select patients at risk. Radiological examination and close monitoring could be restricted to patients with CRP level exceeding 136 mg/l.
authors.affiliation: Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg Cedex, France, benoit.romain@chru-strasbourg.fr.
authors.forename: Benoît
authors.initials: B
authors.lastname: Romain
authors.forename: Rodrigue
authors.initials: R
authors.lastname: Chemaly
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Natalia
authors.initials: N
authors.lastname: Chilintseva
authors.forename: Elhocine
authors.initials: E
authors.lastname: Triki
authors.forename: Cécile
authors.initials: C
authors.lastname: Brigand
authors.forename: Serge
authors.initials: S
authors.lastname: Rohr
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D002097:C-Reactive Protein