Yung Lee1,2, Tyler McKechnie1,2, Aristithes G Doumouras2,3, Chovav Handler3, Cagla Eskicioglu2,3, Scott Gmora2,3, Mehran Anvari2,3, Dennis Hong4,5. 1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. 2. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 3. Division of General Surgery, Department of Surgery, St. Joseph Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. 4. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. dennishong70@gmail.com. 5. Division of General Surgery, Department of Surgery, St. Joseph Healthcare, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. dennishong70@gmail.com.
Abstract
BACKGROUND: Bariatric surgery involves the risk of postoperative infectious complications, in particular, anastomotic leaks and intra-abdominal abscesses. C-reactive protein (CRP) is a nonspecific marker of inflammation which has gained attention as a test to predict postoperative infectious complications. This systematic review and meta-analysis evaluated the diagnostic value of CRP to detect postoperative infectious complications after bariatric surgery. METHODS: Search of MEDLINE, EMBASE, CENTRAL, and PubMed databases were performed. Articles measuring serum CRP postoperatively in patients with obesity undergoing bariatric surgery were included. Main outcomes included diagnostic value of postoperative serum CRP (area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)). Diagnostic accuracy of included studies was assessed using QUADAS-2. RESULTS: Six studies including 2770 patients met the inclusion criteria. The derived CRP cutoff values were 71.4 mg/dL, 130.3 mg/dL, and 118.7 mg/dL on postoperative days (PODs) 1, 3, and 5, respectively. Pooled AUC was similar across PODs 1, 3, and 5 with AUC being highest on POD 5 (0.88 ± 0.07). PPV was between 19 and 21%, and NPV was between 98 and 99%. CRP levels were significantly higher (P < .0001) in postoperative infectious complication group versus the no complication group on PODs 3 and 5. CONCLUSIONS: High NPV and moderately high sensitivity on PODs 1, 3, and 5 may help predict patients who are at a low risk of infectious complication following bariatric surgery. High specificity on PODs 1 and 3 also indicates that it can be useful for early diagnosis of postoperative infectious complications.
BACKGROUND: Bariatric surgery involves the risk of postoperative infectious complications, in particular, anastomotic leaks and intra-abdominal abscesses. C-reactive protein (CRP) is a nonspecific marker of inflammation which has gained attention as a test to predict postoperative infectious complications. This systematic review and meta-analysis evaluated the diagnostic value of CRP to detect postoperative infectious complications after bariatric surgery. METHODS: Search of MEDLINE, EMBASE, CENTRAL, and PubMed databases were performed. Articles measuring serum CRP postoperatively in patients with obesity undergoing bariatric surgery were included. Main outcomes included diagnostic value of postoperative serum CRP (area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV)). Diagnostic accuracy of included studies was assessed using QUADAS-2. RESULTS: Six studies including 2770 patients met the inclusion criteria. The derived CRP cutoff values were 71.4 mg/dL, 130.3 mg/dL, and 118.7 mg/dL on postoperative days (PODs) 1, 3, and 5, respectively. Pooled AUC was similar across PODs 1, 3, and 5 with AUC being highest on POD 5 (0.88 ± 0.07). PPV was between 19 and 21%, and NPV was between 98 and 99%. CRP levels were significantly higher (P < .0001) in postoperative infectious complication group versus the no complication group on PODs 3 and 5. CONCLUSIONS: High NPV and moderately high sensitivity on PODs 1, 3, and 5 may help predict patients who are at a low risk of infectious complication following bariatric surgery. High specificity on PODs 1 and 3 also indicates that it can be useful for early diagnosis of postoperative infectious complications.
Entities:
Keywords:
Anastomotic leak; Bariatric surgery; C-reactive; Postoperative infectious complication; Protein
Authors: Alberto Romano; Ester Del Vescovo; Serena Rivetti; Silvia Triarico; Giorgio Attinà; Stefano Mastrangelo; Palma Maurizi; Antonio Ruggiero Journal: J Pers Med Date: 2022-05-27
Authors: Belinda De Simone; Elie Chouillard; Almino C Ramos; Gianfranco Donatelli; Tadeja Pintar; Rahul Gupta; Federica Renzi; Kamal Mahawar; Brijesh Madhok; Stefano Maccatrozzo; Fikri M Abu-Zidan; Ernest E Moore; Dieter G Weber; Federico Coccolini; Salomone Di Saverio; Andrew Kirkpatrick; Vishal G Shelat; Francesco Amico; Emmanouil Pikoulis; Marco Ceresoli; Joseph M Galante; Imtiaz Wani; Nicola De' Angelis; Andreas Hecker; Gabriele Sganga; Edward Tan; Zsolt J Balogh; Miklosh Bala; Raul Coimbra; Dimitrios Damaskos; Luca Ansaloni; Massimo Sartelli; Nikolaos Parasas; Yoram Kluger; Elias Chahine; Vanni Agnoletti; Gustavo Fraga; Walter L Biffl; Fausto Catena Journal: World J Emerg Surg Date: 2022-09-27 Impact factor: 8.165