C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

Olivares, M.; Martínez, María Labalde; Torralba, Miguel; Fraile, José Ramón Rodríguez; Martínez, Juan Carlos Atance

doi:10.1002/jso.24909

Cited by 39 publications

(22 citation statements)

References 36 publications

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“…The patients’ NRS pain scores were also positively associated with postoperative CRP levels (on POD 1–3) and increase of CRP levels (on POD 2–3). These results not only add to the findings of previous studies that showed CRP level is a clinical marker related to postoperative recovery,12,19 but also show CRP level may reflect postoperative pain outcome.…”

Section: Discussionsupporting

confidence: 86%

“…Moreover, our findings suggest that a decrease in postoperative CRP levels is closely associated with postoperative pain intensity and opioid requirement of patients. Lastly, minimizing postoperative CRP elevation through more minimally invasive surgical procedures is important to reduce the length of stay12,23 and for lower postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, several lines of evidence suggest a correlation between opioid dosage and CRP level. In addition, associations between CRP levels and surgical stress and postoperative recovery have been recently reported 12. Accordingly, CRP levels may be associated with patients’ postoperative opioid requirements and pain scores, and correlations may exist between perioperative CRP levels and an increase in CRP levels, and a patient’s opioid analgesic requirements and severity of postoperative pain.…”

Section: Introductionmentioning

confidence: 98%

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<p>Perioperative C-reactive protein is associated with pain outcomes after major laparoscopic abdominal surgery: a retrospective analysis</p>

Choi¹,

Song²,

Oh³

et al. 2019

JPR

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Purpose: This study is aimed to investigate an association between perioperative C-reactive protein (CRP) levels and both opioid consumption and postoperative pain scores in postoperative days (PODs) in patients who underwent laparoscopic major abdominal surgery. We hypothesized that postoperative opioid requirements and numeric rating scale (NRS) pain scores would be positively associated with perioperative CRP levels. Patients and method: Medical records from 4,653 patients who underwent a laparoscopic major abdominal surgery from January 2010 to December 2016 were retrospectively reviewed. Generalized linear regression analysis was used to identify the association of preoperative and postoperative CRP levels, and increase in CRP level (postoperative CRP level – preoperative CRP level) with postoperative pain outcomes during POD 0–3. Results: An increase of 1 mg dL −1 of postoperative CRP level was significantly associated with 1.4% increase morphine equivalent consumption [exponentiated regression (Exp) coefficient: 0.014, 95% CI (0.011, 0.016), P <0.001], whereas preoperative CRP levels were not significantly associated with morphine equivalent consumption on POD 0–3 ( P =0.450). A 1 mg dL −1 of increase in CRP level was significantly associated with 1% increase of morphine equivalent consumption [Exp coefficient: 0.010, 95% CI (0.008, 0.012), P <0.001]. Postoperative CRP levels were positively associated with NRS pain scores on POD 1, POD 2, and POD 3 ( P <0.001). Increases of CRP levels were also positively associated with NRS pain scores on POD 0, POD 1, POD2, and POD3 ( P <0.05). Conclusion: These results suggest postoperative CRP levels and increases in CRP levels are positively associated with opioid consumption and higher pain scores after major laparoscopic abdominal surgery.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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<p>Perioperative C-reactive protein is associated with pain outcomes after major laparoscopic abdominal surgery: a retrospective analysis</p>

Choi¹,

Song²,

Oh³

et al. 2019

JPR

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“…The serum inflammatory factors, CRP and IL-6 were associated with surgical stress, surgical injury and inflammatory reaction 41 43. This meta-analysis demonstrated that CRP of POD 1, 3/4 and 7 in the ERAS group was lower than in the control group, and there was a significant decrease for IL-6 of POD 1 and 4 compared with the control group.…”

Section: Discussionmentioning

confidence: 73%

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Changsheng

Feng

2019

Postgraduate Medical Journal

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PurposeThis study aimed to assess the safety and efficiency of the enhanced recovery after surgery (ERAS) protocol in radical gastrectomy.MethodsStudies published before February 2019 were searched from EMBASE, PubMed, Cochrane Library and Quanfang databases without language and region restrictions. A total of 15 randomised controlled trials (RCTs) with 1216 participants were included in the analysis, of whom 605 underwent ERAS protocol and 611 received traditional perioperative treatment for radical gastrectomy.ResultsThere was a significant reduction in pulmonary infection (p=0.02) after radical gastrectomy. Further, there was a significant decrease in the length of postoperative hospital days (p<0.00001), first passage time of defection and flatus (p<0.00001), and medical cost (p<0.0001) in the group that received the ERAS protocol. However, the ERAS protocol group had a higher risk for readmission (p=0.007), vomiting (p=0.002) and gastric retention (p=0.0003) compared with the traditional treatment group.ConclusionsERAS protocol application for radical gastrectomy accelerated postoperative recovery, shortened postoperative hospital days and first passage time of defection and flatus, and saved on medical costs, and did not increase the occurrence rate of severe complications.

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“…Higher levels of CRP on postoperative day (POD) 1 was reportedly associated with postoperative complications after gastrointestinal surgery [ 5 , 6 , 13 ]. Furthermore, higher levels of surgical invasion during gastrointestinal surgery increase CRP levels on POD1 [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

et al. 2020

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Background Postoperative serum concentration of C-reactive protein (CRP) is one of the objective quantitative indices integrating the effects of preoperative and intraoperative variables. Higher levels of CRP after gastrointestinal surgery are associated with major postoperative complications. To develop a model for predicting CRP levels on postoperative day (POD) 1 in surgical patients both with and without serious conditions and comorbidities, we modified the previous formula for prediction of CRP levels on POD1, and assessed the accuracy of our modified predictive formula for CRP levels. Material and methods Consecutive patients of all ages undergoing gastrointestinal surgery under general anesthesia were enrolled in this single-institution prospective cohort study. We developed a modified predictive formula in a calculation cohort. Next, associations between measured CRP levels on POD1, predicted CRP levels on POD1 using the previous and modified models, and major complications after surgery were examined in a validation cohort. Results We obtained the following model in the calculation cohort (n = 222): Modified model for predicting CRP levels on POD1 (mg•dL-1) =-10.13 + 0.0025 Duration of surgery (min) + 15.9 Mean Nociceptive Response (NR) + 0.66 Preoperative CRP level (mg•dL-1). In the validation cohort (n = 440), there was a significant association between measured and predicted CRP levels on POD1 (P < 0.001) No significant difference between the measured and predicted CRP levels using the modified model was observed (P = 0.847). There were also significant associations between the predicted CRP levels and major complications after surgery.

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C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

Abstract: The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.

Cited by 39 publications

References 36 publications

<p>Perioperative C-reactive protein is associated with pain outcomes after major laparoscopic abdominal surgery: a retrospective analysis</p>

<p>Perioperative C-reactive protein is associated with pain outcomes after major laparoscopic abdominal surgery: a retrospective analysis</p>

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Modified model for predicting early C-reactive protein levels after gastrointestinal surgery: A prospective cohort study

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