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C-Reactive Protein 2 Days After Laparoscopic Gastric Bypass Surgery Reliably Indicates Leaks and Moderately Predicts Morbidity

Warschkow, Rene ; Tarantino, Ignazio ; Folie, Patrick ; Beutner, Ulrich ; Schmied, Bruno ; Bisang, Philipp ; Schultes, Bernd ; Thurnheer, Martin

In: Journal of Gastrointestinal Surgery, 2012, vol. 16, no. 6, p. 1128-1135

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    Titre
    • C-Reactive Protein 2 Days After Laparoscopic Gastric Bypass Surgery Reliably Indicates Leaks and Moderately Predicts Morbidity
    Auteur
    • Warschkow, Rene. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Tarantino, Ignazio. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Folie, Patrick. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Beutner, Ulrich. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Schmied, Bruno. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Bisang, Philipp. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Schultes, Bernd. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    • Thurnheer, Martin. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Journal of Gastrointestinal Surgery, 2012, vol. 16, no. 6, p. 1128-1135. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:310941
    Summary
    Background: The aim of the present study was to evaluate whether serum C-reactive protein (CRP) is a useful predictor of early post-operative complications, particularly of intestinal leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Methods: The present study was a retrospective analysis of a prospectively maintained database with 809 patients who underwent LRYGB from 2002 until 2011. For 410 of these patients, at least one CRP measurement within the first seven post-operative days was available. The diagnostic value was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: Forty-nine of 410 patients (12.0%; 95% confidence intervals [95% CI], 9.2-15.5%) developed surgery-related complications. Leaks occurred in 17 patients (4.1%; 95% CI, 2.6-6.5%) at a median of 5days after surgery. CRP levels 2days after surgery showed the highest diagnostic value for post-operative complications (AUC, 0.74; 95% CI, 0.60-0.89). Sensitivity was 0.53 (95% CI, 0.31-0.74) and specificity was 0.91 (95% CI, 0.79-0.96) on day 2 (cutoff level, 229mg/l). The sensitivity for intestinal leaks was 1.00 (95% CI, 0.51-1.00). Conclusion: CRP on post-operative day 2 is a valuable predictor of post-operative complications, in particular intestinal leaks. Radiological imaging studies for intestinal leaks could be restricted to patients with CRP values exceeding 229mg/l