title: Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study.
abstract: BACKGROUND
  Serum concentration of C-reactive protein (CRP) that exceeds a pre-defined threshold between the 3rd and 5th postoperative day is a reliable marker of infectious complications after colorectal surgery. However, the optimal strategy to follow when a high CRP is found has not been defined. The aim of this study was to analyze the usefulness of computed tomography (CT) scan in this situation in a prospective cohort of patients following colorectal surgery.
  
  
  METHODS
  Between November 2011 and April 2015, patients at two surgical centers who had undergone elective colorectal resection with anastomosis and who had a CRP>12.5mg/dL on the 4th postoperative day (POD) were prospectively included in a database. Data were collected concerning all complications occurring during the 30days following surgery, method of diagnosis, management and clinical course. The decision to perform a CT scan between POD 4 and POD 6 day was guided only by the elevation of CRP in the absence of any other clinical signs; results were analyzed to evaluate the diagnostic value of elevated CRP. Uni- and multivariable analyses were performed to identify risk factors for postoperative infection.
  
  
  RESULTS
  The study included a total of 174 patients: 56 (32.1%) had a CT between POD 4 and 6, and this helped detect a postoperative complication in 55.4% of cases. Patients who did not undergo CT had lower CRP values (16.3 vs. 18.5, P=0.02). Among the 118 patients who did not undergo CT, 50.8% eventually developed an infectious complication. The sensitivity of CRP-guided CT was 76.7% with a negative predictive value of 78.8%.
  
  
  CONCLUSIONS
  If an elevated CRP is found on POD 4, an abdominopelvic CT should be performed. A normal result does not formally eliminate the existence of intra-abdominal complication. A study protocol should be set up to evaluate whether systematic revisional surgery or repeat CT scan is the appropriate management if CRP in the next two days reveals persistent inflammation.
authors.affiliation: Service de chirurgie générale, digestive, cancérologique et d'urgences, CHU de Dijon, 21079 Dijon, France.
authors.forename: S
authors.initials: S
authors.lastname: Holl
authors.affiliation: Centre d'investigation clinique, CIC 1432, CHU de Dijon, Dijon, France.
authors.forename: I
authors.initials: I
authors.lastname: Fournel
authors.affiliation: Service de chirurgie cancérologique, centre de lutte contre le cancer « G.-F.-Leclerc », Dijon, France.
authors.forename: D
authors.initials: D
authors.lastname: Orry
authors.affiliation: Service de chirurgie générale, digestive, cancérologique et d'urgences, CHU de Dijon, 21079 Dijon, France; Centre de recherche Inserm 866, UFR Sciences de Santé, université de Bourgogne-Franche-Comté, Dijon, France.
authors.forename: O
authors.initials: O
authors.lastname: Facy
authors.affiliation: Service de chirurgie générale, digestive, cancérologique et d'urgences, CHU de Dijon, 21079 Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Cheynel
authors.affiliation: Service de chirurgie générale, digestive, cancérologique et d'urgences, CHU de Dijon, 21079 Dijon, France; Centre de recherche Inserm 866, UFR Sciences de Santé, université de Bourgogne-Franche-Comté, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Rat
authors.affiliation: Service de chirurgie générale, digestive, cancérologique et d'urgences, CHU de Dijon, 21079 Dijon, France; Centre de recherche Inserm 866, UFR Sciences de Santé, université de Bourgogne-Franche-Comté, Dijon, France. Electronic address: pablo.ortega-deballon@chu-dijon.fr.
authors.forename: P
authors.initials: P
authors.lastname: Ortega-Deballon
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Abdominal computerized tomography; Anastomotic leak; C-reactive protein; CT; Intra-abdominal infection; Surgical site infection