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Revista Colombiana de Cirugía
versão impressa ISSN 2011-7582versão On-line ISSN 2619-6107
Resumo
BORRAEZ-SEGURA, Bernardo et al. C-reactive protein and its progression over time for the detection of anastomotic leaks. rev. colomb. cir. [online]. 2023, vol.38, n.2, pp.283-288. Epub 23-Jan-2023. ISSN 2011-7582. https://doi.org/10.30944/20117582.2290.
Introduction.
Anastomotic leaks are a common and critical complication in gastrointestinal surgery. Their identification and early treatment are necessary to avoid adverse results, and conventional use with a cutoff value of C-reactive protein has shown limited utility. The objective of this study was to determine the usefulness of serial measurement of C-reactive protein in the detection of anastomotic leaks.
Methods.
Prospective review of a retrospective database of patients undergoing major abdominal surgery with at least one intestinal anastomosis. C-reactive protein was measured on the third and fifth postoperative days. Complications were classified according to the Clavien-Dindo classification. Diagnostic accuracy was evaluated by the area under the curve.
Results.
157 patients were included, 52% were females. The average age was 63.7 years. The largest number of surgeries corresponded to gastrectomies (36.3%), anterior resection of the rectum (15.3%) and right hemicolectomies (13.4%). 25.5% had some postoperative complication and 32.5% (n=13) had anastomosis leaks. The increase in C-reactive protein had an area under the curve of 0.918 with an increase cut-off point of 1.3 mg/L, sensitivity of 92.3% (95% CI 78-100) and specificity of 92.4%. (95% CI 88-96).
Conclusions.
The 1.3 mg/L increase in C-reactive protein between the day of surgery and the fifth day was an accurate predictor of anastomotic leaks in patients with major abdominal surgery.
Palavras-chave : C-reactive protein; surgical anastomosis; digestive system surgical procedures; gastrectomy; postoperative complications; anastomotic leak; clinical evolution.