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

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Abstract
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. 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 multivariate analysis were performed. Diagnostic accuracy was evaluated using receiver operating curves. 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/m2. 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/m2 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). Monitoring CRP level in laparoscopic colorectal surgery demonstrated a high diagnostic accuracy for infectious complications, thus allowing for safe and early discharge.

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