Abstract
Background
The primary objective of this study was to evaluate the utility of CRP in early identification of post-operative complications after bariatric surgery. The ability of this marker to acutely predict post-operative complications in bariatric surgery patients has not been determined.
Methods
A retrospective chart review was conducted of adult patients who underwent a primary and revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between 2013 and 2017 at a single institution. Patients were identified using the prospective Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. CRP levels were drawn on post-operative day one per standard protocol. Univariate analyses were performed to determine the predictive impact of CRP levels on post-operative complications, readmissions, and reoperations.
Results
There were 275 patients who underwent bariatric surgery, 222 primary and 53 revisional. Of the 275 patients, 36 (13.1%) had a complication. Bariatric surgery patients with a post-operative complication had higher CRP levels compared to those who did not (4.8 ± 4.6 vs. 2.9 ± 2.0; p = 0.02). A CRP ≥ 5 mg/dL had a sensitivity for a complication of 27% and a specificity of 88%. There was no difference in CRP levels for patients with a 30-day reoperation or readmission. There were no mortalities.
Conclusions
Bariatric surgery patients with elevated post-operative CRP levels are at increased risk for 30-day complications. The low sensitivity of a CRP ≥ 5 mg/dL suggests that a normal CRP level alone does not rule out the possibility of a post-operative complication. However, with its high specificity, there should be an elevated clinical suspicion of a post-operative complication in patients with a CRP ≥ 5 mg/dL.
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Matthew Goldblatt is a speaker and consultant for WL Gore and Medtronic, a consultant for Allergan, and receives research funding from Bard and Merck. Jon Gould is a consultant for Torax Medical. Ashley Villard, Melissa Helm, Tammy L. Kindel, and Rana Higgins have no conflicts of interest or financial ties to disclose.
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Villard, M.A., Helm, M.C., Kindel, T.L. et al. C-Reactive protein as a predictor of post-operative complications in bariatric surgery patients. Surg Endosc 33, 2479–2484 (2019). https://doi.org/10.1007/s00464-018-6534-0
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DOI: https://doi.org/10.1007/s00464-018-6534-0