Abstract
Purpose
C-reactive protein and procalcitonin are reliable early predictors of infection after colorectal surgery. However, the inflammatory response is lower after laparoscopy as compared to open surgery. This study analyzed whether a different cutoff value of inflammatory markers should be chosen according to the surgical approach.
Methods
A prospective, observational study included consecutive patients undergoing elective colorectal surgery in three academic centers. All infections until postoperative day (POD) 30 were recorded. The inflammatory markers were analyzed daily until POD 4. Areas under the ROC curve and diagnostic values were calculated in order to assess their accuracy as a predictor of intra-abdominal infection.
Results
Five-hundred-one patients were included. The incidence of intra-abdominal infection was 11.8%. The median levels of C-reactive protein (CRP) and procalcitonin (PCT) were lower in the laparoscopy group at each postoperative day (p < 0.0001). In patients without intra-abdominal infection, they were also lower in the laparoscopy group (p = 0.0036) but were not different in patients presenting with intra-abdominal infections (p = 0.3243). In the laparoscopy group, CRP at POD 4 was the most accurate predictor of overall and intra-abdominal infection (AUC = 0.775). With a cutoff of 100 mg/L, it yielded 95.7% negative predictive value, 75% sensitivity, and 70.3% specificity for the detection of intra-abdominal infection.
Conclusion
The impact of infection on inflammatory markers is more important than that of the surgical approach. Defining a specific cutoff value for early discharge according to the surgical approach is not justified. A patient with CRP values lower than 100 mg/L on POD 4 can be safely discharged.
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Acknowledgments
The authors thank the data monitoring board (Cassandra Porebski, Emilie Galizzi, Sandrine Vinault, Alexandra Felin, Amandine Martin, Fanny Lachaux, Donya Souhiel Da Costa, Joelle Fritsch, Chrystelle Cappe), the safety monitoring board (Aurélie Grandvuillemin, Pharm.D.), the administrative support team (Evelyne Phu and Maud Carpentier), and the staff of the participant surgical departments for their help and Mr. Philip Bastable for the language revision of the manuscript. C. Binquet had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Support was provided by the Groupement de Coopération Sanitaire Grand-Est, the Regional Council of Burgundy, and by a grant from BRAHMS France SAS.
List of investigators (in alphabetical order)
University Hospital of Dijon: Christine Binquet, M.D., Ph.D, MPH; Pierre-Emmanuel Charles, M.D., Ph.D; Nicolas Cheynel, M.D., Ph.D.; Giovanni Di Giacomo, M.D.; Olivier Facy, M.D., Ph.D.; Isabelle Fournel, M.D., Ph.D.; David Masson, Pharm.D, Ph.D.; Pablo Ortega-Deballon, M.D., Ph.D.; Patrick Rat, M.D.
University Hospital of Besançon: Bruno Heyd, M.D.; Georges Mantion, M.D.; Brice Paquette, M.D.
“Georges F Leclerc” Anticancer Centre: Jean Fraisse, M.D.; David Orry, M.D.
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
The study was funded by the Groupement de Coopération Sanitaire Grand-Est, the Regional Council of Burgundy, a grant from Brahms France SAS, and French Government grant managed by the French National Research Agency (ANR) under the “Investissements d’Avenir” program with reference ANR-11-LABX-0021-01-LipSTIC Labex.
ClinicalTrials.gov number: NCT01510314.
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Facy, O., Paquette, B., Orry, D. et al. Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy?. Int J Colorectal Dis 32, 857–863 (2017). https://doi.org/10.1007/s00384-017-2805-9
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DOI: https://doi.org/10.1007/s00384-017-2805-9