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21.04.2018 | Original Contributions

C-Reactive Protein on Postoperative Day 1: a Predictor of Early Intra-abdominal Infections After Bariatric Surgery

Zeitschrift:
Obesity Surgery
Autoren:
Dino Kröll, Dominik Nakhostin, Guido Stirnimann, Suna Erdem, Tobias Haltmeier, Philipp Christoph Nett, Yves Michael Borbély
Wichtige Hinweise
Christoph Nett and Yves Michael Borbély shared last authorship.

Abstract

Background

Early intra-abdominal infections (IAI) compromise short-term outcomes in bariatric surgery. The timely detection of IAI is challenging but essential to prevent major sequelae of such complications. C-reactive protein (CRP) is a reliable marker for detecting IAI after colorectal surgery. In bariatric surgery, data on CRP as a marker for IAI are limited, particularly for postoperative day one (POD1).

Objective

The objective of this study was to assess CRP on POD1 as a predictor for early IAI (within 7 days following surgery) in patients after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).

Methods

Patients with bariatric surgery between 08/2010 and 06/2017 were included. The predictive capacity of CRP for early IAI was determined using a receiver operating characteristics (ROC) analysis.

Results

In 523 patients (68.5% female, LSG = 358, LRYGB = 165), 16 (3%) early IAI were observed. ROC analysis revealed a significant predictive capacity of POD1 CRP for early IAI, with a sensitivity and a specificity of 81.2 and 94.3%, respectively, at a CRP cut-off value of 70 mg/L. In patients with confirmed early IAI, 81.3% had a CRP level ≥ 70 mg/L (LSG 85.7%, LRYGB 77.8%). The negative predictive value for a CRP level < 70 mg/L was 99.4% overall and was 100 and 98% for LSG and LRYGB, respectively.

Conclusion

In patients with a CRP level < 70 mg/L on POD1, early IAI can be excluded with high accuracy in bariatric patients. Thus, early postoperative CRP may be used to assess the risk of early IAI in enhanced recovery programs.

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