CT Scan in the Postoperative Management of Colorectal Surgery Complications: Balancing Clinical Usefulness and Overuse

Abstract To evaluate whether computed tomography (CT) was overused in the early postoperative period in oncologic colorectal surgery. We conducted a single-center retrospective study including all patients who underwent colorectal resection with an anastomosis for colorectal adenocarcinoma between 2018 and 2022. The indications and findings of postoperative abdominopelvic CT scans performed during the initial hospital stay were collected, excluding the CT scans performed after discharge. A total of 1,091 patients were included. The overall morbidity rate was of 32%. Abdominopelvic CT scans were performed in 284 patients (26%), including 25% for isolated C-reactive protein (CRP) elevation without clinical signs. In total, 30% of the scans performed (n = 84) were normal, with 93% of those patients subsequently experiencing no severe postoperative complications. In cases of isolated CRP elevation, the rate of normal abdominopelvic CT scans was of 38%. In the multivariate analysis, we identified 3 factors associated with a normal abdominopelvic CT: scans performed within the first 4 postoperative days (p = 0.004), isolated CRP elevation (p = 0.010), and absence of a diverting ileostomy (p = 0.044). A predictive score based on these factors showed probabilities of a normal CT of 7%, 22%, 35%, and 54% when 0, 1, 2, or 3 factors were present respectively. Among patients with a normal scan, 39% were discharged within 24 hours, rising to 68% when the CT was performed for isolated CRP elevation. Postoperative abdominopelvic CT scans are frequently performed after colorectal surgery, with normal findings in about 1/3 of the cases in our experience. When normal—especially in the context of isolated CRP elevation—abdominopelvic CT scans exclude major complications and help accelerate an earlier and safe patient discharge.