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Early C-reactive protein after colorectal surgery is not predictive of anastomotic leak: a retrospective cohort study

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Abstract

Purpose

Prior studies suggest postoperative C-reactive protein (CRP) trends are sensitive for predicting anastomotic leak (AL) after elective colorectal surgery. However, in the setting of enhanced recovery pathways, multi-day CRP trends may not be feasible. This study aimed to assess the realistic and clinical utility of CRP in prediction of AL.

Methods

A retrospective review of patients who underwent elective colectomy or proctectomy from January 2019 to October 2020 at a single institution was performed. Comorbidities, operative characteristics, and perioperative outcomes were recorded. CRP was checked routinely on POD1 and on a clinical basis subsequently. The association between 10-point change in CRP-POD1 and AL was evaluated using multivariable logistic regression. The relationships between CRP-POD3, CRP-POD1, and AL were assessed using exploratory analyses.

Results

Among 332 patients, 23 (6.9%) developed AL, of which 9 cases (39%) were diagnosed upon readmission. AL was not associated with mortality. Median length of stay was 3 days (IQR 2–5). Median days to AL diagnosis was 7 (IQR 4–15). Adjusting for diverting stoma, steroid use, diagnosis, and open surgery, each 10-point increase in CRP was associated with increased odds of AL (OR 1.12, 95% CI 1.03–1.21, p=0.008). CRP-POD1 had poor discriminant utility for detecting AL (AUC 0.62, 95% CI = 0.494–0.746; p=0.061).

Conclusion

CRP on POD1 is not a reliable method to predict a leak, and trending CRP may not be practical with decreasing lengths of stay in colorectal surgery.

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Author notes

  1. Evangelos Messaris

    Present address: Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA

    Praachi Raje, Benjamin G. Allar, Kevin R. Arndt & Kristen T. Crowell

  2. Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA

    Praachi Raje, Benjamin G. Allar, Kevin R. Arndt, Kristen T. Crowell & Evangelos Messaris

Authors
  1. Praachi Raje
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  2. Benjamin G. Allar
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Contributions

Each author certifies that he or she has made direct and substantial contribution to the work reported in this manuscript. All authors contributed to study conception and design. Data collection was performed by Praachi Raje, Benjamin G. Allar, and Kevin Arndt. Data analysis was performed by Benjamin G. Allar. The manuscript was written by Praachi Raje, Benjamin G. Allar, and Kevin Arndt. Critical revisions were provided by Evangelos Messaris and Kristen Crowell. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Praachi Raje.

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Ethics approval

This research was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of our institution who determined that our study did not need ethical approval, and an IRB official waiver of ethical approval was granted.

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Raje, P., Allar, B.G., Arndt, K.R. et al. Early C-reactive protein after colorectal surgery is not predictive of anastomotic leak: a retrospective cohort study. Langenbecks Arch Surg 408, 142 (2023). https://doi.org/10.1007/s00423-023-02884-7

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  • DOI: https://doi.org/10.1007/s00423-023-02884-7

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