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Should They Stay or Should They Go? The Utility of C-Reactive Protein in Predicting Readmission and Anastomotic Leak After Colorectal Resection

Pantel, Haddon J., M.D.1; Jasak, Lisa J., R.N, B.S.N.1; Ricciardi, Rocco, M.D., M.P.H.2,3; Marcello, Peter W., M.D.2; Roberts, Patricia L., M.D.2; Schoetz, David J. Jr., M.D.2; Read, Thomas E., M.D.2

doi: 10.1097/DCR.0000000000001225
Original Contributions: Socioeconomic
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BACKGROUND: Hospital readmission and anastomotic leak following colorectal resection have a negative impact on patients, surgeons, and the health care system. Novel markers of patients unlikely to experience these complications are of value in avoiding readmission.

OBJECTIVE: This study aimed to determine the predictive value of C-reactive protein for readmission and anastomotic leak within 30 days following colorectal resection.

DESIGN: This is a retrospective review of a prospectively compiled single-institution database.

PATIENTS: From January 1, 2013, to July 20, 2017, consecutive patients undergoing elective colorectal resection with anastomosis without the presence of proximal intestinal stoma, who had C-reactive protein measured on postoperative day 3, were included.

MAIN OUTCOME MEASURES: The primary outcome measured was the predictive value of C-reactive protein measured on postoperative day 3 for readmission or anastomotic leak within 30 days after colorectal resection.

RESULTS: Of the 752 patients examined, 73 (10%) were readmitted within 30 days of surgery and 17 (2%) had an anastomotic leak. Mean C-reactive protein in patients who neither had an anastomotic leak nor were readmitted (127 ± 77 mg/L) was lower than for patients who were readmitted (157 ± 96 mg/L, p = 0.002) and lower than for patients who had an anastomotic leak (228 ± 123 mg/L, p = 0.0000002). The area under the receiver operating characteristic curve for the diagnostic accuracy of C-reactive protein for readmission was 0.59, with a cutoff value of 145 mg/L, generating a 93% negative predictive value. The area under the curve for the diagnostic accuracy of C-reactive protein for anastomotic leak was 0.76, with a cutoff value of 147 mg/L generating a 99% negative predictive value.

LIMITATIONS: This study was limited by its retrospective design and because all patients were treated at a single center.

CONCLUSIONS: Patients with a C-reactive protein below 145 mg/L on postoperative day 3 after colorectal resection have a low likelihood of readmission within 30 days, and a very low likelihood of anastomotic leak. See Video Abstract at http://links.lww.com/DCR/A761.

1 Division of General Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts

2 Division of Colon & Rectal Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts

3 Section of Colon & Rectal Surgery, Massachusetts General Hospital, Boston, Massachusetts

Funding/Support: None reported.

Financial Disclaimers: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Haddon J. Pantel, M.D., Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA, 01850.E-mail: haddon.pantel@lahey.org.

© 2019 The American Society of Colon and Rectal Surgeons