Skip to main content

Advertisement

Log in

C-Reactive Protein on Postoperative Day 1: a Predictor of Early Intra-abdominal Infections After Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Early intra-abdominal infections (IAI) compromise short-term outcomes in bariatric surgery. The timely detection of IAI is challenging but essential to prevent major sequelae of such complications. C-reactive protein (CRP) is a reliable marker for detecting IAI after colorectal surgery. In bariatric surgery, data on CRP as a marker for IAI are limited, particularly for postoperative day one (POD1).

Objective

The objective of this study was to assess CRP on POD1 as a predictor for early IAI (within 7 days following surgery) in patients after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB).

Methods

Patients with bariatric surgery between 08/2010 and 06/2017 were included. The predictive capacity of CRP for early IAI was determined using a receiver operating characteristics (ROC) analysis.

Results

In 523 patients (68.5% female, LSG = 358, LRYGB = 165), 16 (3%) early IAI were observed. ROC analysis revealed a significant predictive capacity of POD1 CRP for early IAI, with a sensitivity and a specificity of 81.2 and 94.3%, respectively, at a CRP cut-off value of 70 mg/L. In patients with confirmed early IAI, 81.3% had a CRP level ≥ 70 mg/L (LSG 85.7%, LRYGB 77.8%). The negative predictive value for a CRP level < 70 mg/L was 99.4% overall and was 100 and 98% for LSG and LRYGB, respectively.

Conclusion

In patients with a CRP level < 70 mg/L on POD1, early IAI can be excluded with high accuracy in bariatric patients. Thus, early postoperative CRP may be used to assess the risk of early IAI in enhanced recovery programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.

    Article  Google Scholar 

  2. Livingston EH. Complications of bariatric surgery. Surg Clin North Am. 2005;85(4):853–68. vii. PubMed PMID: 16061090

    Article  Google Scholar 

  3. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 32-5. PubMed PMID: 17950357

    Article  Google Scholar 

  4. Gonzalez R, Sarr MG, Smith CD, et al. Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity. J Am Coll Surg. 2007;204(1):47–55.

    Article  Google Scholar 

  5. Lee SD, Khouzam MN, Kellum JM, et al. Selective, versus routine, upper gastrointestinal series leads to equal morbidity and reduced hospital stay in laparoscopic gastric bypass patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2007;3(4):413–6.

    Article  Google Scholar 

  6. Carter JT, Tafreshian S, Campos GM, et al. Routine upper GI series after gastric bypass does not reliably identify anastomotic leaks or predict stricture formation. Surg Endosc. 2007;21(12):2172–7.

    Article  CAS  Google Scholar 

  7. Adamina M, Steffen T, Tarantino I, et al. Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg. 2015;102(6):590–8.

    Article  CAS  Google Scholar 

  8. Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg. 2012;256(2):245–50.

    Article  Google Scholar 

  9. Albanopoulos K, Alevizos L, Natoudi M, et al. C-reactive protein, white blood cells, and neutrophils as early predictors of postoperative complications in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc. 2013;27(3):864–71.

    Article  Google Scholar 

  10. Romain B, Chemaly R, Meyer N, et al. Diagnostic markers of postoperative morbidity after laparoscopic Roux-en-Y gastric bypass for obesity. Langenbeck's Arch Surg. 2014;399(4):503–8.

    Article  Google Scholar 

  11. Csendes A, Burgos AM, Roizblatt D, et al. Inflammatory response measured by body temperature, C-reactive protein and white blood cell count 1, 3, and 5 days after laparotomic or laparoscopic gastric bypass surgery. Obes Surg. 2009;19(7):890–3.

    Article  Google Scholar 

  12. Warschkow R, Tarantino I, Folie P, et al. C-reactive protein 2 days after laparoscopic gastric bypass surgery reliably indicates leaks and moderately predicts morbidity. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2012;16(6):1128–35.

    Article  Google Scholar 

  13. Williams MR, McMeekin S, Wilson RJ, et al. Predictive value of C-reactive protein for complications post-laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2017;27(3):709–15.

    Article  Google Scholar 

  14. Khorgami Z, Petrosky JA, Andalib A, et al. Fast track bariatric surgery: safety of discharge on the first postoperative day after bariatric surgery. Surg Obes Relat Dis. 2017;13(2):273–80.

    Article  Google Scholar 

  15. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27(2):97–132. quiz 3-4; discussion 96

    Article  CAS  Google Scholar 

  16. Sax H, Swiss N. [Nationwide surveillance of nosocomial infections in Switzerland—methods and results of the Swiss Nosocomial Infection Prevalence Studies (SNIP) in 1999 and 2002]. Therapeutische Umschau Revue therapeutique. 2004 Mar;61(3):197–203. PubMed PMID: 15058471. Uberwachung der nosokomialen Infektionen in der Schweiz--Methode und Resultate der wiederholten nationalen Pravalenzstudien

  17. Singh PP, Zeng IS, Srinivasa S, et al. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–46.

    Article  CAS  Google Scholar 

  18. Cousin F, Ortega-Deballon P, Bourredjem A, et al. Diagnostic accuracy of procalcitonin and C-reactive protein for the early diagnosis of intra-abdominal infection after elective colorectal surgery: a meta-analysis. Ann Surg. 2016 Aug;264(2):252–6.

    Article  Google Scholar 

  19. Pike TW, White AD, Snook NJ, et al. Simplified fast-track laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(3):413–7.

    Article  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  21. Munoz JL, Ruiz-Tovar J, Miranda E, et al. C-reactive protein and procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program. J Am Coll Surg. 2016;222(5):831–7.

    Article  Google Scholar 

  22. Ruiz-Tovar J, Munoz JL, Gonzalez J, et al. C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery (ERAS) program. Surg Endosc. 2017;31:5283–8.

    Article  Google Scholar 

  23. Dupre A, Slim K. Anastomotic leakage after colorectal surgery: can it be detected earlier and more easily? J Visceral Surg. 2012;149(5):e287–8.

    Article  CAS  Google Scholar 

  24. Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg. 2013;23(12):2013–7.

    Article  Google Scholar 

  25. Fernandez Jr AZ, DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–7.

    Article  Google Scholar 

  26. Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23(6):1403–8.

    Article  Google Scholar 

  27. Wener MH, Daum PR, McQuillan GM. The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration. J Rheumatol. 2000;27(10):2351–9.

    CAS  Google Scholar 

  28. Holdstock C, Lind L, Engstrom BE, et al. CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects. Int J Obes. 2005;29(10):1275–80.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dino Kröll.

Ethics declarations

Conflict of Interest

All authors declare no commercial associations that might represent conflicts of interest with this article.

Human and Animal Rights and Informed Consent

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Christoph Nett and Yves Michael Borbély shared last authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kröll, D., Nakhostin, D., Stirnimann, G. et al. C-Reactive Protein on Postoperative Day 1: a Predictor of Early Intra-abdominal Infections After Bariatric Surgery. OBES SURG 28, 2760–2766 (2018). https://doi.org/10.1007/s11695-018-3240-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3240-x

Keywords

Navigation