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Hospital stay for temporary stoma closure is shortened by C-reactive protein monitoring: a prospective case-matched study

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Abstract

Background

C-reactive protein (CRP) has been suggested as a satisfactory early marker of postoperative complications after colorectal surgery. The aim of this study was to assess the impact of a CRP monitoring-driven discharge strategy, after stoma reversal following laparoscopic sphincter-saving surgery for rectal cancer.

Methods

Eighty-eight patients who had stoma reversal between June 2016 and April 2018 had CRP serum level monitoring on postoperative day (POD) 3 and, if necessary, on POD5. Patients were discharged on POD4 if the CRP level was < 100 mg/L. Patients were matched [according to age, gender, body mass index, neoadjuvant pelvic irradiation, type of anastomosis (stapled or manual), and adjuvant chemotherapy] to 109 identical control patients who had stoma reversal between 2012 and 2016 with the same postoperative care but without CRP monitoring.

Results

Postoperative 30-day overall morbidity [CRP group: 12/88 (14%) vs controls: 11/109, (10%), p = 0.441] and severe morbidity rates (i.e. Dindo 3–4) [CRP group: 2/88 (2%) vs controls: 2/109 (2%), p = 0.838] were similar between groups. Mean length of stay was significantly shorter in the CRP group (CRP group: 4.6 ± 1.3 vs controls: 5.8 ± 1.8 days; p < 0.001). Discharge occurred before POD5 in 59/88 (67%) CRP patients vs 15/109 (14%) controls (p < 0.001). The unplanned rehospitalization rate [CRP group: 6/88 (7%) vs controls: 4/109 (4%), p = 0.347] was similar between groups.

Conclusions

In patients having temporary stoma closure after laparoscopic surgery for rectal cancer, postoperative CRP monitoring is associated with a significant shortening of hospital stay without increasing morbidity or rehospitalization rates.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France

    E. Hain, L. Maggiori, A. Laforest, A. Frontali, J. Prost à la Denise & Y. Panis

Authors
  1. E. Hain
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  2. L. Maggiori
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  3. A. Laforest
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  4. A. Frontali
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  5. J. Prost à la Denise
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  6. Y. Panis
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Correspondence to Y. Panis.

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The authors declare that they have no financial disclosure or conflict of interest.

Ethical approval

This study was approved by our institutional review board, conducted according to the ethical standards of the Committee on Human Experimentation of our institution, and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

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Hain, E., Maggiori, L., Laforest, A. et al. Hospital stay for temporary stoma closure is shortened by C-reactive protein monitoring: a prospective case-matched study. Tech Coloproctol 23, 453–459 (2019). https://doi.org/10.1007/s10151-019-02003-z

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  • DOI: https://doi.org/10.1007/s10151-019-02003-z

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