title: Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study.
abstract: The aim of the present study was to examine whether a C-reactive protein (CRP) first approach would improve the detection rate of postoperative complications by CT.CRP is a useful biomarker to identify major complications following surgery for colorectal cancer.Patients with histologically confirmed colorectal cancer, who underwent elective surgery between 2008 and 2015 at a single centre were included. Exceeding the established CRP threshold of 150 mg/L on postoperative day (POD) 4 was recorded. Results of CT performed between postoperative days 4 and 14 were recorded.Four hundred ninety-five patients were included. The majority were male (58%), over 65 (68%), with node-negative disease (66%) and underwent open surgery (70%). Those patients who underwent a CT scan (n = 93), versus those who did not (n = 402), were more likely to have a postoperative complication (84% vs 35%, P < 0.001), infective complication (67% vs 21%, P < 0.001), and anastomotic leak (17% vs 2%, P < 0.001). In patients who did not undergo a CT scan (n = 402) exceeding the CRP threshold (n = 117) on POD 4 was associated with a higher rate of postoperative complication (50% vs 29%, P < 0.001), infective complications (36% vs 15%, P < 0.001), and anastomotic leak (4% vs 0.5%, P = 0.009). In patients who did undergo a CT scan (n = 93) exceeding the CRP threshold (n = 53) on POD 4 was associated with earlier CT (median POD 6 vs 8, P = 0.001) but not postoperative complications.A CRP first approach resulted in earlier and improved detection of complications by CT following surgery for colorectal cancer.
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McSorley
authors.forename: Bo Y
authors.initials: BY
authors.lastname: Khor
authors.forename: Graham J
authors.initials: GJ
authors.lastname: MacKay
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein