Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study.

Résumé : Introduction: Serum concentration of C-reactive protein (CRP) that exceeds a pre-defined threshold between the 3rd and 5th postoperative day is a reliable marker of infectious complications after colorectal surgery. However, the optimal strategy to follow when a high CRP is found has not been defined. The aim of this study was to analyze the usefulness of computed tomography (CT) scan in this situation in a prospective cohort of patients following colorectal surgery. Methods: Between November 2011 and April 2015, patients at two surgical centers who had undergone elective colorectal resection with anastomosis and who had a CRP > 12.5 mg/dL on the 4th postoperative day (POD) were prospectively included in a database. Data were collected concerning all complications occurring during the 30 days following surgery, method of diagnosis, management and clinical course. The decision to perform a CT scan between POD 4 and POD 6 day was guided only by the elevation of CRP in the absence of any other clinical signs; results were analyzed to evaluate the diagnostic value of elevated CRP. Uni- and multivariable analyses were performed to identify risk factors for postoperative infection. Results: The study included a total of 174 patients: 56 (32.1%) had a CT between POD 4 and 6, and this helped detect a postoperative complication in 55.4% of cases. Patients who did not undergo CT had lower CRP values (16.3 vs. 18.5, P = 0.02). Among the 118 patients who did not undergo CT, 50.8% eventually developed an infectious complication. The sensitivity of CRP-guided CT was 76.7% with a negative predictive value of 78.8%.
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https://hal-univ-bourgogne.archives-ouvertes.fr/hal-01556466
Contributeur : Lnc - Université de Bourgogne <>
Soumis le : mercredi 5 juillet 2017 - 10:53:26
Dernière modification le : mercredi 5 septembre 2018 - 17:04:03

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S. Holl, I. Fournel, D. Orry, Olivier Facy, N Cheynel, et al.. Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study.. Journal of Visceral Surgery, Elsevier, 2017, 154 (1), pp.5-9. 〈http://www.sciencedirect.com/science/article/pii/S1878788616300947〉. 〈10.1016/j.jviscsurg.2016.07.003〉. 〈hal-01556466〉

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