A C-reactive protein level below 140 mg/L on postoperative day 2 after major colorectal surgery yielded a 98.6% negative predictive value for anastomotic leak, supporting safe early discharge.
Observational (n=434)
No
Does C-reactive protein measurement on postoperative day 2 predict safe discharge in patients undergoing colorectal surgery for cancer?
A C-reactive protein level below 140 mg/L on postoperative day 2 has a high negative predictive value for complications, supporting safe early discharge in selected patients after colorectal surgery.
Abstract Background Enhanced Recovery After Surgery (ERAS) has enabled early patient discharge, but reliable biomarkers are needed to support safe early discharges. C-reactive protein levels have been reported as good markers for early anastomotic leak detection and also for overall complications, but there is no consensus yet on its quantification nor day of analysis. Objective This study aimed to determine the C-reactive protein cutoff values at postoperative day (POD) 2–4 associated with the lowest risk of postoperative complications. Design Single-center, retrospective study. Settings Tertiary hospital. Patients Patients operated on between 2019 and 2022. Interventions Surgery for colorectal cancer. Main outcome measures C-reactive protein on postoperative days 2–4 and the delta difference between postoperative days 3 and 2 were measured, identifying the best cutoff value for each postoperative complication. Receiver-operating characteristics curves were generated and the area under the curve was analyzed for each postoperative day measurement. Results A total of 434 patients were included, median age was 72 (62–80) years. On postoperative day-2, the cutoff values for overall morbidity, surgical complications, medical complications, and anastomotic leak were 139.2 mg/L, 144.4 mg/L, 140 mg/L, and 170 mg/L, respectively. POD3 and 2 were both safe (area under the curve of 0.7507 and 0.7466, respectively). The negative predictive values using a C-reactive protein POD2 cutoff value of 140 mg/L were 80.6%, 91.5%, 87.6%, and 98.6% for global, medical, surgical complications, and anastomotic leak, respectively. Limitations Retrospective study. Conclusions Carefully selected, motivated, and clinically suitable patients could be offered discharge on POD2 if their C-reactive protein levels are below 140 mg/L, with a very high negative predictive value for anastomotic leak and other postoperative complications. This decision should be made in collaboration with patients, considering clinical assessment and logistic factors.
Kraft et al. (Fri,) conducted a observational in Colorectal cancer (n=434). C-reactive protein (CRP) measurement was evaluated on Best C-reactive protein cutoff value for postoperative complications on postoperative day 2. A C-reactive protein level below 140 mg/L on postoperative day 2 after major colorectal surgery yielded a 98.6% negative predictive value for anastomotic leak, supporting safe early discharge.