Predictive Value of C-Reactive Protein for Complications Post-Laparoscopic Roux-En-Y Gastric Bypass
- 420 Downloads
Laparoscopic roux-en-Y gastric bypass (LRYGB) has gained increasing popularity as the primary procedure of choice for the management of patients with morbid obesity. Despite the advances, a few patients will still develop complications and predicting these early complications in morbidly obese patients can prove to be difficult. Radiological investigations have limited diagnostic value and have associated side effects and cost. We propose that C-reactive protein (CRP) is a useful predictor for early postoperative complications.
This study aims to determine the ability of CRP taken on postoperative day 1 (POD 1) and 2 to predict occurrence of complications within 30 days of surgery.
This retrospective observational study selected 183 consecutive patients from the York bariatric database between 01 December 2010 and 23 March 2015. Exclusions: Patients undergoing dual procedures, conversion to open, and if no postoperative CRP measurement was performed.
In total, 138 patients satisfied the inclusion criteria during the study period (median age 44 years [20–68], BMI 50.6 kg/m2 [38.3–62.5]). Fifteen (10.8 %) patients had minor complications (CD of 2) and 8 (5.6 %) had major complications (CD 3 or above). A CRP of greater than 127 mg/L on POD 2 was found to predict complications with 93 % sensitivity and 64 % specificity with diagnostic accuracy 0.82 (95 % confidence interval 0.731–0.908).
In our patients, CRP on POD 2 has been shown to be a good predictor of both minor and major complications and can therefore be used to guide clinicians in making decision as to which patients may need further investigation or who can be safely discharged.
KeywordsLaparoscopic roux-en Y gastric bypass C-reactive protein CRP ROC curve analysis Bariatric surgery Postoperative complications
The authors would like to acknowledge the help of Mr. David Locker for his hard work and maintaining the prospective bariatric patient database.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study, formal consent is not required. Informed consent does not apply to this submission.
- 4.Straatman J, Van der Peet D. C-reactive protein after major abdominal surgery: biochemical and clinical aspects. Amsterdam Medical Student Journal. 2015;2:1–3.Google Scholar
- 6.Takeno A, Takiguchi S, Fujita J, Tamura S, Imamura H, Fujitani K, Matsuyama J, Mori M, Doki Y. Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis. Ann Surg Oncol. 2013;20(11):3527–33.CrossRefPubMedGoogle Scholar
- 9.Warsi A, Heptinstall L, Asaria M, Passafiume F, Jaw M, Barecca M, Whitelaw D, Jain VK. The significance of routine white cell count (WCC) and C-reactive protein (CRP) measurements following laparoscopic roux-en-Y-gastric bypass (LRYGB). Obesity Surg. 2012;22(9):1362.Google Scholar
- 10.Aguilo R, Agrawell S. Fast track laparoscopic roux-en-y gastric bypass surgery. Obes Surg. 2013;23(8):1195.Google Scholar