Monitoring c-reactive protein after laparoscopic colorectal surgery excludes infectious complications and allows for safe and early discharge.
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).


CONCLUSIONS
Monitoring CRP level in laparoscopic colorectal surgery demonstrated a high diagnostic accuracy for infectious complications, thus allowing for safe and early discharge.
Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland, michel.adamina@gmail.com.
Michel
M
Adamina
Rene
R
Warschkow
Franziska
F
Näf
Bianka
B
Hummel
Thomas
T
Rduch
Jochen
J
Lange
Thomas
T
Steffen
D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D002097:C-Reactive Protein / Q000378:metabolism*; D003108:Colonic Diseases / Q000601:surgery*; D003428:Cross Infection / Q000175:diagnosis* / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011184:Postoperative Period; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012680:Sensitivity and Specificity
D002097:C-Reactive Protein