title: Preoperative inflammation increases the risk of infection after elective colorectal surgery: results from a prospective cohort.
abstract: BACKGROUND
  Septic complications after colorectal surgery are frequent and sometimes life threatening. It is well known that inflammation impairs the healing process. It has been suggested that preoperative ongoing inflammation could increase the risk of postoperative infections. This study aimed to elucidate the role of preoperative inflammation on postoperative infectious complications and to understand if, through biological markers, it is possible to identify preoperatively patients at higher risk of infection.
  
  
  METHODS
  A prospective, observational study was conducted in three centers from November 2011 to April 2014. Consecutive patients undergoing elective colorectal surgery with anastomosis were included. Any ongoing infection was an exclusion criterion. C-reactive protein, albumin, prealbumin, and procalcitonin plasma levels were measured preoperatively. Postoperative infections were recorded according to the definitions of the Centers for Diseases Control. The areas under the receiver operating characteristic curve were analyzed and compared to assess the accuracy of each preoperative marker.
  
  
  RESULTS
  Four-hundred and seventy two patients were analyzed. Infectious complications occurred in 118 patients (25 %) and mortality in 6 patients (1.3 %). In the univariate analysis, preoperative C-reactive protein and albuminemia were found significantly associated with postoperative infectious complications (P = 0.008 and P = 0.0002, respectively). Areas under the ROC curve for preoperative C-reactive protein and albuminemia were 0.57and 0.62, respectively.
  
  
  CONCLUSIONS
  This study confirms the association between preoperative inflammatory activity, hypoalbuminemia, and the onset of infections after surgery. Trials aiming to decrease the inflammatory activity before surgery in order to prevent postoperative complications are warranted.
authors.affiliation: Department of Digestive Surgery, Dijon University Hospital, Dijon, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: De Magistris
authors.affiliation: Department of Digestive Surgery, Besançon University Hospital, Besançon, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Paquette
authors.affiliation: Department of Surgery, Anticancer Centre "Georges-François Leclerc", Dijon, France.
authors.forename: David
authors.initials: D
authors.lastname: Orry
authors.affiliation: Department of Digestive Surgery, Dijon University Hospital, Dijon, France.|INSERM, U866, University of Burgundy and Franche-Comte, Dijon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Facy
authors.affiliation: Department of Digestive Surgery, Dijon University Hospital, Dijon, France.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Giacomo
authors.affiliation: Department of Digestive Surgery, Dijon University Hospital, Dijon, France.|INSERM, U866, University of Burgundy and Franche-Comte, Dijon, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rat
authors.affiliation: INSERM, U866, University of Burgundy and Franche-Comte, Dijon, France.|Clinical Epidemiology Unit, INSERM, CIC1432, Dijon University Hospital, Dijon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.affiliation: Department of Digestive Surgery, Dijon University Hospital, Dijon, France. pablo.ortega-deballon@chu-dijon.fr.|INSERM, U866, University of Burgundy and Franche-Comte, Dijon, France. pablo.ortega-deballon@chu-dijon.fr.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ortega-Deballon
mesh_terms: D003107:Colorectal Surgery / Q000009:adverse effects*; D003141:Communicable Diseases / Q000209:etiology*; D003710:Demography; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation / Q000150:complications* / Q000473:pathology*; D009017:Morbidity; D009747:Nutritional Physiological Phenomena; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors
keywords: Albumin; Anastomotic leak; C-reactive protein; Colorectal surgery; Intra-abdominal infection; Postoperative complications; Procalcitonin; Surgical site infection