Dino Kröll1, Dominik Nakhostin2, Guido Stirnimann2, Suna Erdem2, Tobias Haltmeier2, Philipp Christoph Nett2, Yves Michael Borbély2. 1. Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, Switzerland, 3010, Bern, Switzerland. dino.kroell@insel.ch. 2. Department of Visceral Surgery and Medicine, Inselspital Bern, Bern University Hospital and University of Bern, Switzerland, 3010, Bern, Switzerland.
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.
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.
Entities:
Keywords:
C-reactive protein; Intra-abdominal infections; Organ space surgical site infections; Postoperative complications; ROC curve analysis; Roux-en-Y gastric bypass; Sleeve gastrectomy
Authors: Rene Warschkow; Ulrich Beutner; Thomas Steffen; Sascha A Müller; Bruno M Schmied; Ulrich Güller; Ignazio Tarantino Journal: Ann Surg Date: 2012-08 Impact factor: 12.969
Authors: José Luis Muñoz; Jaime Ruiz-Tovar; Elena Miranda; Diana Lorena Berrio; Pedro Moya; Manuel Gutiérrez; Raquel Flores; Carlos Picó; Ana Pérez Journal: J Am Coll Surg Date: 2016-02-13 Impact factor: 6.113