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Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study

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Abstract

Purpose

Infectious complications (ICs) after mesh-reinforced ventral hernioplasty often lead to prolonged and complicated hospitalizations. As early diagnosis and management can mitigate complications, early prediction is important. Our aim was to determine whether postoperative blood tests are valuable predictors of IC.

Methods

We retrospectively analyzed 373 patients who underwent conventional ventral hernioplasty with mesh augmentation between 2008 and 2011. The clinical outcome was correlated with postoperative serum C-reactive protein (CRP) and white blood cell counts (WBC) and assessed by area under the curve (AUC) analysis of the receiver operating characteristics curve.

Results

ICs occurred in 51 (13.7%) patients, who required further management. Among these, 48 patients developed a procedure-related complication, the most frequent being surgical site infection (n = 44). The infections appeared after a median postoperative delay of 12 days. Serum CRP was superior to WBC in the prediction of a complicated course. A maximum CRP < 105 mg/L on postoperative day (POD) 2 or 3 had the highest negative predictive value (NPV; 100%) in ruling out ICs [positive predictive value (PPV) 29%; sensitivity 100%; specificity 55%]. The PPV for occurrence of IC improved each day after surgery, reaching up to 46% on POD 5 or 6 for a CRP cut-off of 63.2 mg/L (NPV 93%; sensitivity 69%; specificity 83%). The AUC was 0.80 at both time points.

Conclusions

Our results indicate that postoperative serum CRP allows for early prediction of the postoperative course. Low CRP during the initial PODs is associated with lower risk of ICs. Higher levels on POD 5 or 6 behoove close surveillance.

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Authors and Affiliations

  1. Department of Visceral, General and Thoracic Surgery, Marienhospital Stuttgart, Böheimstr. 37, 70199, Stuttgart, Germany

    J. Pochhammer, B. Scholtes & M. Schäffer

  2. Department of Anesthesiology, Intensive Care and Pain Medicine, Marienhospital Stuttgart, Stuttgart, Germany

    J. Keuler

  3. Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    B. Müssle & T. Welsch

Authors
  1. J. Pochhammer
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  2. B. Scholtes
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  3. J. Keuler
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  4. B. Müssle
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  5. T. Welsch
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  6. M. Schäffer
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Corresponding author

Correspondence to J. Pochhammer.

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Conflict of interest

Dres. Pochhammer, Scholtes, Keuler, Müssle, Welsch and Schäffer declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional Ethics Committee of our hospital.

Human and animal rights

The article does not contain any studies directly involving human participants, as it is a review of data already collected in a hernia database.

Informed consent

For this type of study, formal consent is not required. This study complied with the current laws of the Federal Republic of Germany.

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Pochhammer, J., Scholtes, B., Keuler, J. et al. Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study. Hernia 24, 41–48 (2020). https://doi.org/10.1007/s10029-018-1844-7

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  • DOI: https://doi.org/10.1007/s10029-018-1844-7

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