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

作者：Adamina Michel^*; Warschkow Rene; Naef Franziska; Hummel Bianka; Rduch Thomas; Lange Jochen; Steffen Thomas

来源：Surgical Endoscopy and Other Interventional Techniques, 2014, 28(10): 2939-2948.

DOI：10.1007/s00464-014-3556-0

• Laparoscopic colorectal surgery
• Infectious complications
• Diagnostic test
• C-reactive protein
• Perioperative care pathway

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 multi-variate 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).
Conclusion Monitoring CRP level in laparoscopic colorectal surgery demonstrated a high diagnostic accuracy for infectious complications, thus allowing for safe and early discharge.

• 出版日期2014-10