Introduction
Material and methods
Search strategy
Study selection
Test outcome
Reference standard
Study design, patient characteristics, and quality
Meta-analysis
Results
Study and patient characteristics
Reference | Inclusion period | No. of participants | Type of surgery | Follow-up duration | Age | Female sex (%) | Primary outcomes |
---|---|---|---|---|---|---|---|
Aguilar-Nascimento [39], Brazil | 2004–2005 | 32 | Major gastrointestinal surgery with at least one anastomosis | NS | 49 (range 18–72) | 14 (46 %) | Infectious morbidity |
Albanopoulos [40], Greece | 2008–2011 | 177 | Laparoscopic sleeve gastrectomy | 30 days | 38.1 (range 18–61) | 102 (58 %) | Postoperative complications within 30 days |
Dutta [14], UK | 2005–2009 | 136 | Esophagogastric cancer resections | 7 days | (Age <65, 65–75, >75) | 37 (27 %) | Postoperative complications |
No complications 37/25/7 | |||||||
Infectious complications 26/21/7 | |||||||
Noninfectious complications 6/6/1 | |||||||
Garcia-Granero [41], Spain | 2008–2010 | 205 | Elective colorectal surgery with primary intestinal anastomosis | 60 days after discharge | 63.3 SD (15.5) | 93 (45, 4 %) | Complications |
Guirao [19], Spain | 2007–2009 | 208 | Open or laparoscopic colorectal surgery | 30 days | 68.3 SD (11.4) | 82 (39.4 %) | Organ space infection |
Lagouttea [42], France | 2010–2011 | 100 | Elective colonic or rectal surgery with immediate restoration of intestinal continuity | 30 days after surgery | 64 (range 20–87) | 42 (42 %) | Complications |
Mackay [2], UK | 2003–2006 | 150 | Elective colorectal resection | 30 days | 72 (IQR 63–79) | 78 (52 %) | Infective complications |
Matsuda [25], Japan | 2006–2007 | 41 | Elective colorectal surgery | 30 days | Uninfected 69.5 ± 2.0 | Uninfected 15 (52 %) | Postoperative infections |
Infected 69.7 ± 2.7 | Infected 1 (8.3 %) | ||||||
Matthiessena [1], Sweden | 2002–2003 | 33 | Anterior resection for rectal carcinoma | NS | 68 (range 38–80) | 11 (33 %) | Anastomotic leakage |
Oberhofer [43], Croatia | 2009 | 79 | Elective colorectal surgery | NS | Complications 65.7 | 29 (37 %) | Complications |
No complications 79.8 | |||||||
Ortega–Deballon [30], France | 2007–2008 | 133 | Elective colorectal surgery | 6 weeks | 65 ± 16 | 48 (36 %) | Septic complications (including leaks, wound infections, central line infection, urinary tract infection, pneumonia) |
Platt [13], UK | 1997–2007 | 454 | Curative resection for colorectal cancer | 7 days | (Age <65, 65–75, >75) | 275 (61 %) | Complications (infective and noninfective) |
No complications 120/99/115 | |||||||
Infective complications 30/41/33 | |||||||
Noninfective complications 1/8/7 | |||||||
Ramanathana [44], UK | NS | 357 | Curative surgery for colorectal cancer | 30 days | (<65/65–74/>74 years) | 169 (47 %) | Infective complications |
99/113/145 (28/32/40 %) | |||||||
Reitha [37] Germany | NS | 70 | Aortal surgery (n = 35) | 10 days | NS | NS | Complications |
Colorectal surgery (n = 35) | |||||||
Scepanovic [45], Serbia and Montenegro | 2010–2012 | 156 | Elective abdominal surgery with primary anastomosis | 30 days | 65 (28–86) | 67 (42.9 %) | Postoperative complications (infectious and noninfectious) |
Shimizu[46], Japan | 1997–1999 | 112 | Gastrointestinal surgery | 4 weeks | Noninfected 60 ± 2 | 65 (58 %) | Infectious complications |
Minor infected 68 ± 2 | |||||||
Severely infected 68 ± 4 | |||||||
Siassia [47], Germany | 2000–2001 | 172 | Major elective surgery for malignant disease of the gastrointestinal tract | NS | 62.3 (25–83) | 116 (67 %) | Postoperative complications |
Takakura [48], Japan | 2010–2011 | 114 | Colonic surgery | NS | Noncomplicated 65 (32–92) | Noncomplicated 33 (85 %) | SSI (superficial and deep) |
Complicated 61 (42–82) median, range | Complicated 6 (15 %) | ||||||
Van Genderen [4], The Netherlands | 2007–2008 | 63 | Elective esophagectomy with gastric tube reconstruction | 10 days after surgery | 61 ± 8.9 | 18 (29 %) | Complications |
Veeramootooa [49], UK | 2004–2006 | 50 | Minimally invasive esophagectomy | NS | 67 (47–81) | 5 (10 %) | Complications |
Welsch [50], Germany | 2002–2005 | 688 | Pancreatic resections with pancreaticojejunostomy for neoplasms and chronic pancreatitis | 12 days | NS | NS | Inflammatory postoperative complications |
Welsch [5], Germany | 2001–2005 | 96 | Rectal resections with sphincter preserving primary anastomosis | 12 days | Complicated: 65.0 (59.7–75.5) | 28 (29 %) | Infectious postoperative complications |
No complications 66.8 (61.1–71.8) |
Quality of included studies/risk of bias
Predictive value of CRP for infectious complications
POD | Number of studies (n = patients) | Mean CRP level (95 % CI) | Mean CRP level (95 % CI) |
---|---|---|---|
Complicated (infectious) | Uncomplicated | ||
1 | 5 (n = 593) | 122 (52–288) | 67 (36–123) |
2 | 5 (n = 641) | 195 (91–420) | 146 (65–329) |
3 | 5 (n = 593) | 190 (125–289) | 98 (50–195) |
4 | 2 (n = 338) | 170 (165–174) | 95 (78–116) |
5 | 5 (n = 663) | 188 (71–497) | 62 (28–139) |
POD | Number of studies (n = patients) | Pooled incidence PIC (%) | Pooled AUC | Pooled CRP cutoff (range) | Pooled sensitivity (95 % CI) | Pooled specificity (95 % CI) | Pooled PPV (95 % CI) | Pooled NPV (95 % CI) | Pooled LR+ (95 % CI) | Pooled LR− (95 % CI) |
---|---|---|---|---|---|---|---|---|---|---|
1 | 4 (n = 546) | 18 | 0.73 | 157 (109–187) | 60 % (47–71 %) | 60 % (43–75 %) | 41 % (27–56 %) | 82 % (68–90 %) | 1.48 (0.66–2.30) | 0.67 (0.33–1.02) |
2 | 6 (n = 881)a
| 24 | 0.72 | 190 (140–240) | 66 % (54–76 %) | 66 % (50–79 %) | 45 % (31–60 %) | 84 % (72–91 %) | 1.95 (0.87–3.03) | 0.51 (0.27–0.76) |
3 | 9 (n = 1567) | 32 | 0.87 | 159 (92–200) | 77 % (68–84 %) | 77 % (64–87 %) | 57 % (43–71 %) | 90 % (81–95 %) | 3.41 (1.43–5.39) | 0.29 (0.16–0.43) |
4 | 6 (n = 894) | 33 | 0.82 | 132 (101–180) | 80 % (71–86 %) | 80 % (67–88 %) | 60 % (45–73 %) | 91 % (83–95 %) | 3.93 (1.58–6.28) | 0.26 (0.13–0.38) |
5 | 6 (n = 1104)a
| 17 | 0.83 | 114 (48–150) | 86 % (79–91 %) | 86 % (75–92 %) | 64 % (49–77 %) | 92 % (85–96 %) | 6.07 (2.26–9.89) | 0.17 (0.09–0.25) |